CPCS Ongoing Monitoring and Audits 2

Question 1

Which federal database must credentialing organizations query as part of ongoing monitoring to identify providers with adverse actions against their Medicare/Medicaid participation?

Accepted Answer

OIG List of Excluded Individuals and Entities

Answer

The OIG List of Excluded Individuals and Entities (LEIE) must be checked to ensure providers have not been excluded from federal healthcare programs.

Question 2

A hospital's medical staff office discovers mid-cycle that a physician's Drug Enforcement Administration (DEA) registration expired three weeks ago. What is the immediate required action?

Accepted Answer

Notify the department chief and restrict the physician from prescribing controlled substances

Answer

An expired DEA registration must trigger immediate restriction of controlled substance prescribing privileges until the registration is renewed.

Question 3

What term describes the process of reviewing a provider's performance data, complaints, and licensure status between full recredentialing cycles?

Accepted Answer

Ongoing Professional Practice Evaluation (OPPE)

Answer

OPPE is the continuous review of practitioner performance data used to inform decisions about maintaining, modifying, or revoking privileges.

Question 4

When conducting ongoing monitoring, how frequently does The Joint Commission recommend that organizations review OPPE data for licensed independent practitioners?

Accepted Answer

At least every 12 months but organizations may set shorter intervals

Answer

TJC requires OPPE data be reviewed at defined intervals that must not exceed 12 months, though organizations may review more frequently.

Question 5

A credentialing specialist receives an automated alert that a practitioner's malpractice insurance policy will lapse in 10 days. Which action reflects best practice?

Accepted Answer

Contact the practitioner and require proof of renewed coverage before the lapse date

Answer

Proactive outreach to require proof of renewed coverage before a lapse protects the organization and maintains continuous compliance.

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS Ongoing Monitoring and Audits 2