CPCS Initial Application Processing 4

Question 1

What is the significance of the OIG List of Excluded Individuals/Entities (LEIE) in initial credentialing?

Accepted Answer

It identifies individuals and entities excluded from participating in federal healthcare programs

Answer

The OIG LEIE must be queried to ensure the provider is not excluded from participation in Medicare, Medicaid, or other federal healthcare programs.

Question 2

Which credentialing standard requires organizations to have a mechanism for providers to correct inaccuracies in their application?

Accepted Answer

Fair Hearing and Appeals Plan

Answer

The Fair Hearing and Appeals Plan ensures providers have due process rights, including the ability to challenge and correct adverse credentialing decisions or inaccuracies.

Question 3

A provider's application lists board certification as 'in progress.' How should this be documented during the initial credentialing process?

Accepted Answer

Document the pending status and note that certification must be verified before privileges are granted or at defined deadline

Answer

Pending board certification should be documented with any applicable deadlines, and the organization's policy determines whether temporary privileges may be granted during the process.

Question 4

Under The Joint Commission standards, how often must primary source verification be completed for an existing license that has already been verified?

Accepted Answer

At each reappointment cycle, typically every 2 years

Answer

TJC standards require re-verification of ongoing licensure at each reappointment, which typically occurs every two years.

Question 5

What is the purpose of the 'release and consent' section of an initial credentialing application?

Accepted Answer

It allows the organization to contact references and release information to third parties during the credentialing process

Answer

The release and consent section authorizes the organization to perform background checks, contact references, and share credentialing information with authorized parties.

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS Initial Application Processing 4