CPCS MCQ 3 — Questions and Answers
Question 1: Which element is NOT typically verified during the initial credentialing process?
- Medical school graduation
- Board certification
- Personal credit score (Correct answer)
- State licensure
Correct answer: Personal credit score
Personal credit scores are not a standard element of healthcare provider credentialing.
Question 2: A hospital's medical staff bylaws establish the formal framework for which credentialing activity?
- Insurance contract negotiation
- Granting clinical privileges (Correct answer)
- Billing and coding compliance
- HIPAA security rule compliance
Correct answer: Granting clinical privileges
Medical staff bylaws define the process and criteria for granting, denying, and revoking clinical privileges.
Question 3: The OIG Exclusion Database must be checked during credentialing because it identifies providers who:
- Have outstanding student loan debt
- Are excluded from participating in federal healthcare programs (Correct answer)
- Have not completed continuing education
- Practice in states with reciprocity agreements
Correct answer: Are excluded from participating in federal healthcare programs
The OIG Exclusion Database lists individuals excluded from Medicare, Medicaid, and other federal healthcare programs.
Question 4: What is the primary purpose of a 'focused professional practice evaluation' (FPPE)?
- Annual performance review for all staff
- Evaluating a new or newly privileged practitioner's competence over a defined period (Correct answer)
- Investigating a billing compliance violation
- Determining salary adjustments
Correct answer: Evaluating a new or newly privileged practitioner's competence over a defined period
FPPE is a time-limited monitoring process used to assess practitioners who are new to an organization or newly granted privileges.
Question 5: Which scenario would most likely trigger an 'ongoing professional practice evaluation' (OPPE)?
- A provider completing an initial credentialing application
- A routine review of practitioner performance data over time (Correct answer)
- A provider changing their mailing address
- A new physician seeking temporary privileges
Correct answer: A routine review of practitioner performance data over time
OPPE is the continuous, data-driven monitoring of a practitioner's performance used to inform re-credentialing decisions.
Question 6: When a provider's license is suspended by a state board, the credentialing specialist should:
- Wait until re-credentialing to address the issue
- Immediately notify medical staff leadership per established policy (Correct answer)
- Contact the provider's malpractice insurer
- Update the record and take no further action
Correct answer: Immediately notify medical staff leadership per established policy
A license suspension is a critical event requiring immediate escalation to medical staff leadership per organizational policy.
Question 7: Which term describes the process by which one organization accepts another's credentialing decisions without full re-verification?
- Delegated credentialing (Correct answer)
- Proxy credentialing
- Reciprocal endorsement
- Expedited privileging
Correct answer: Delegated credentialing
Delegated credentialing allows one entity to rely on another's credentialing work, subject to oversight and contractual agreement.
CPCS MCQ 3
Which element is NOT typically verified during the initial credentialing process?