CPCS Knowledge 5

Question 1

Which URAC credentialing standard specifically addresses the time frame within which an organization must complete re-credentialing?

Accepted Answer

URAC CR 6

Answer

URAC CR 6 addresses re-credentialing cycle time requirements, specifying that re-credentialing must be completed within 36 months.

Question 2

What is the purpose of a 'tail coverage' endorsement on a claims-made malpractice policy?

Accepted Answer

To cover claims filed after the policy expires for incidents that occurred during the policy period

Answer

Tail coverage (extended reporting endorsement) covers claims submitted after a claims-made policy ends, as long as the incident occurred while the policy was active.

Question 3

Which body has authority to exclude practitioners from participating in Medicare and Medicaid programs?

Accepted Answer

Office of Inspector General (OIG), HHS

Answer

The OIG has statutory authority to exclude individuals and entities from Medicare, Medicaid, and other federal healthcare programs.

Question 4

A credentialing file is considered 'complete' when which condition is met?

Accepted Answer

All required primary source verifications have been received and the application is ready for committee review

Answer

A complete credentialing file means all primary source verifications have been returned and all required documentation is on hand, making the file ready for committee review.

Question 5

Under NCQA standards, which practitioner type is exempt from credentialing requirements for health plans?

Accepted Answer

Practitioners providing only administrative services with no direct patient care

Answer

NCQA exempts practitioners who perform only administrative or non-clinical roles from credentialing requirements because they provide no direct patient care.

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS Knowledge 5