CPCS Knowledge 2

Question 1

Which organization publishes the USMLE Step examinations used to verify physician competency?

Accepted Answer

National Board of Medical Examiners (NBME) and FSMB jointly

Answer

The USMLE is co-sponsored by the NBME and the Federation of State Medical Boards (FSMB).

Question 2

What is the primary purpose of the National Practitioner Data Bank (NPDB) in the credentialing process?

Accepted Answer

To provide a repository of adverse actions and malpractice payments for query during credentialing

Answer

The NPDB is a federal repository that credentialers query to identify adverse licensure actions, malpractice payments, and clinical privilege restrictions.

Question 3

Under NCQA standards, how often must a healthcare organization re-credential its participating practitioners?

Accepted Answer

Every 3 years

Answer

NCQA requires re-credentialing at least every 36 months (3 years) to maintain accreditation.

Question 4

Which document formally delegates credentialing authority from a hospital's governing board to the medical staff?

Accepted Answer

Bylaws

Answer

Hospital bylaws define the structure through which the governing board delegates credentialing and privileging decisions to the medical staff.

Question 5

A practitioner's application lists a gap in work history of 14 months. Per best credentialing practice, what should the credentialing specialist do?

Accepted Answer

Request a written explanation and supporting documentation from the practitioner

Answer

Unexplained employment gaps must be addressed by requesting a written explanation and any relevant documentation before the file advances.

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS Knowledge 2