CPCS MCQ 5

Question 1

Under NCQA credentialing standards, which of the following may be used as an acceptable alternative to primary source verification of board certification?

Accepted Answer

Verification via the certifying board's online database

Answer

NCQA accepts verification through a certifying board's publicly available online database as equivalent to primary source verification.

Question 2

Which of the following is a key responsibility of a credentials committee?

Accepted Answer

Making recommendations on granting, denying, or modifying clinical privileges

Answer

The credentials committee reviews credentialing files and recommends privilege decisions to the governing body.

Question 3

What does the term 'clean claim' mean in the context of provider credentialing and enrollment?

Accepted Answer

A claim that can be processed without additional information or investigation

Answer

A clean claim contains all required information and can be adjudicated by the payer without additional documentation.

Question 4

A managed care organization delegates credentialing to a hospital. Which element is essential for a compliant delegation agreement?

Accepted Answer

The MCO retains the right to approve, deny, or rescind privileges

Answer

In delegated credentialing, the MCO must retain oversight authority including the right to approve, deny, or rescind provider participation.

Question 5

Which database should be queried to identify providers sanctioned under Medicare or Medicaid programs?

Accepted Answer

OIG List of Excluded Individuals and Entities (LEIE)

Answer

The OIG LEIE specifically identifies individuals and entities excluded from participation in federal healthcare programs including Medicare and Medicaid.

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS MCQ 5