CPCS MCQ 4 — Questions and Answers
Question 1: The Federation of State Medical Boards (FSMB) Data Bank is useful in credentialing primarily because it provides:
- Provider malpractice insurance limits
- Information about physician licenses across all US states and territories (Correct answer)
- Hospital affiliation histories
- Residency graduation dates
Correct answer: Information about physician licenses across all US states and territories
The FSMB provides a centralized record of physician licensure status across all US states and territories.
Question 2: Which type of malpractice insurance requires the policy to be active both when the incident occurs AND when the claim is filed?
- Occurrence-based policy
- Claims-made policy (Correct answer)
- Tail coverage policy
- Blanket liability policy
Correct answer: Claims-made policy
A claims-made policy provides coverage only if the policy is active at both the time of the incident and the time the claim is filed.
Question 3: What is 'tail coverage' in the context of malpractice insurance?
- Coverage that extends backward to incidents before the policy began
- An endorsement that extends claims-made coverage after a policy ends (Correct answer)
- A rider for high-risk procedures only
- Coverage automatically included in all occurrence policies
Correct answer: An endorsement that extends claims-made coverage after a policy ends
Tail coverage is a reporting endorsement that allows claims arising from incidents during the policy period to be filed after the policy terminates.
Question 4: A credentialing specialist receives a reference letter that raises concerns about a physician's clinical judgment. The best next step is to:
- Discard the letter and request a new reference
- Document the concern and refer to the credentials committee for review (Correct answer)
- Contact the applicant and ask them to explain the comment
- Automatically deny the application without further review
Correct answer: Document the concern and refer to the credentials committee for review
Documenting the concern and escalating to the credentials committee ensures a fair, structured review of the red flag.
Question 5: Which accreditation body uses the 'Comprehensive Accreditation Manual for Hospitals' (CAMH) which includes credentialing standards?
- NCQA
- URAC
- The Joint Commission (Correct answer)
- AAAHC
Correct answer: The Joint Commission
The Joint Commission publishes the CAMH, which contains the Medical Staff (MS) chapter with credentialing and privileging standards.
Question 6: When must a credentialing organization query the NPDB under federal law?
- Only when a provider is initially applying for privileges
- At initial appointment and at re-credentialing, and when a practitioner resigns under investigation (Correct answer)
- Annually for all practitioners on the medical staff
- Only when a malpractice claim is reported
Correct answer: At initial appointment and at re-credentialing, and when a practitioner resigns under investigation
Federal law mandates NPDB queries at initial appointment, re-credentialing, and upon resignation of a practitioner under investigation.
Question 7: A physician requests temporary privileges due to an emergency need. Which condition typically must be met for approval?
- Completion of the full credentialing process
- Evidence of current licensure and a pending complete application (Correct answer)
- Board certification in the requested specialty
- Proof of malpractice coverage for at least five years
Correct answer: Evidence of current licensure and a pending complete application
Temporary privileges may be granted while the full application is pending, provided current licensure and other basic requirements are met.
CPCS MCQ 4
The Federation of State Medical Boards (FSMB) Data Bank is useful in credentialing primarily because it provides: