CPCS Primary Source Verification 3 — Questions and Answers
Question 1: What is the primary purpose of the National Practitioner Data Bank (NPDB) in credentialing?
- To replace primary source verification of licensure
- To identify practitioners with a history of malpractice payments or adverse actions (Correct answer)
- To verify board certification status
- To confirm graduate medical education completion
Correct answer: To identify practitioners with a history of malpractice payments or adverse actions
The NPDB tracks malpractice payment reports and adverse licensure, clinical privilege, and professional society membership actions.
Question 2: A credentialing specialist discovers that a provider's license was on probation two years ago but is currently in good standing. What is the correct course of action?
- Approve the application since the license is currently valid
- Deny the application due to prior disciplinary history
- Report the finding to the credentialing committee for review and decision (Correct answer)
- Request that the provider explain the probation in writing only
Correct answer: Report the finding to the credentialing committee for review and decision
Past disciplinary actions must be disclosed to the credentialing committee, which is responsible for making the final determination.
Question 3: Which element is NOT typically verified through primary source verification?
- Medical school graduation
- Board certification
- References from colleagues (Correct answer)
- DEA registration
Correct answer: References from colleagues
Peer references are not primary source documents; they are secondary sources used to assess professional conduct and competence.
Question 4: How should a credentialing specialist handle a primary source that does not respond to a verification request within the required timeframe?
- Approve the application and note the non-response
- Document all attempts and escalate according to organization policy (Correct answer)
- Deny the application due to inability to verify
- Accept the provider's copy of the document as sufficient
Correct answer: Document all attempts and escalate according to organization policy
Credentialing standards require thorough documentation of all verification attempts and following established organizational protocols for non-responses.
Question 5: Which of the following statements about the OIG exclusion list is CORRECT?
- It only applies to physicians
- Organizations may face Civil Monetary Penalties for employing excluded individuals (Correct answer)
- It is only relevant for Medicare Part A services
- Checking it is optional for credentialing purposes
Correct answer: Organizations may face Civil Monetary Penalties for employing excluded individuals
Employing or contracting with OIG-excluded individuals can result in Civil Monetary Penalties for the healthcare organization.
Question 6: When verifying a provider's training through a graduate medical education program that has since closed, what is the best primary source?
- The provider's personal copy of training certificates
- The American Medical Association Physician Masterfile (Correct answer)
- The state medical board where training occurred
- A letter from the program director
Correct answer: The American Medical Association Physician Masterfile
The AMA Physician Masterfile maintains historical training records even for programs that have closed, making it a reliable primary source.
Question 7: Under URAC credentialing standards, what is the maximum allowable gap in a provider's work history that requires explanation?
- 30 days
- 60 days
- 6 months (Correct answer)
- 1 year
Correct answer: 6 months
URAC standards require that gaps in a provider's work history of six months or more be explained and documented.
CPCS Primary Source Verification 3
What is the primary purpose of the National Practitioner Data Bank (NPDB) in credentialing?