CPCS Initial Application Processing 3 — Questions and Answers
Question 1: When verifying a provider's medical education, which source is considered an acceptable primary source?
- The provider's own copy of their diploma
- The American Medical Association (AMA) Physician Masterfile (Correct answer)
- A colleague's written confirmation of the provider's training
- The provider's curriculum vitae
Correct answer: The American Medical Association (AMA) Physician Masterfile
The AMA Physician Masterfile is recognized as an acceptable primary source equivalent for verifying medical education and training.
Question 2: A credentialing specialist receives an application from a provider with clinical privileges at another facility. What should the specialist obtain from that facility?
- A copy of the provider's performance improvement files
- A current performance evaluation or letter of good standing (Correct answer)
- The provider's peer review committee minutes
- The salary records from the previous facility
Correct answer: A current performance evaluation or letter of good standing
Requesting a current performance evaluation or letter confirming good standing from current or previous facilities is standard practice during initial credentialing.
Question 3: Which organization accredits hospitals and requires compliance with credentialing standards, influencing initial application processes?
- Centers for Medicare & Medicaid Services (CMS)
- The Joint Commission (TJC) (Correct answer)
- The American Credentialing Association (ACA)
- The National Committee for Quality Assurance (NCQA)
Correct answer: The Joint Commission (TJC)
The Joint Commission sets credentialing standards for accredited hospitals, and compliance with TJC standards shapes initial application requirements.
Question 4: What is the standard timeframe that a provider has to submit a complete application after being invited to apply for medical staff membership?
- 14 days
- 30 days (Correct answer)
- 60 days
- 90 days
Correct answer: 30 days
Most medical staff bylaws require the provider to submit a complete application within 30 days of receiving the application materials.
Question 5: When reviewing a new application, the specialist discovers the provider has had a malpractice claim that was settled. What is the CORRECT action?
- Immediately deny the application without review
- Request detailed information about the claim for committee review (Correct answer)
- Ignore the settled claim since it is resolved
- Contact the plaintiff's attorney for details
Correct answer: Request detailed information about the claim for committee review
Settled malpractice claims must be disclosed and reviewed; the specialist collects details so the credentialing committee can make an informed decision.
Question 6: A provider applying for hospital privileges holds a license in multiple states. Which license must be verified?
- Only the license in the state where the hospital is located
- Only the license in the state where the provider was trained
- All current active licenses in all states (Correct answer)
- Only the license most recently renewed
Correct answer: All current active licenses in all states
Best practice and most accreditation standards require verification of all active state licenses a provider currently holds.
Question 7: What is the role of the credentialing coordinator when a provider's DEA registration has expired during the application review?
- Approve the application with a condition to renew the DEA later
- Notify the provider and request a current, valid DEA certificate before completing verification (Correct answer)
- Verify the last known DEA number and proceed with approval
- Transfer the file immediately to the medical director for decision
Correct answer: Notify the provider and request a current, valid DEA certificate before completing verification
An expired DEA registration requires the provider to renew and submit a valid certificate before credentialing verification can be completed.
CPCS Initial Application Processing 3
When verifying a provider's medical education, which source is considered an acceptable primary source?