CPCS Primary Source Verification 4

Question 1

A provider's application reveals training at a foreign hospital not accredited by a recognized U.S. body. What is the most appropriate verification method?

Accepted Answer

Contact the foreign hospital directly and use a credentialing verification organization (CVO) if needed

Answer

Direct contact with the institution or use of a qualified CVO experienced in international verification is appropriate for foreign training verification.

Question 2

What does 'continuous enrollment' verification mean in managed care credentialing?

Accepted Answer

Verifying that malpractice coverage has been maintained without lapses

Answer

Continuous enrollment verification in malpractice insurance means confirming there are no gaps in professional liability coverage.

Question 3

Which of the following is an example of a 'sentinel event' flag that would trigger mandatory review during primary source verification?

Accepted Answer

A malpractice payment reported to the NPDB within the past five years

Answer

An NPDB malpractice payment report is a sentinel event that requires mandatory disclosure and review by the credentialing committee.

Question 4

A hospital grants temporary privileges to a provider pending completion of primary source verification. Which standard governs this practice?

Accepted Answer

CMS Conditions of Participation

Answer

CMS Conditions of Participation regulate how hospitals may grant temporary privileges during the credentialing process.

Question 5

Which of the following is a legitimate reason primary source verification may be waived or delegated per accreditation standards?

Accepted Answer

The organization uses a NCQA-certified CVO that has already performed verification

Answer

NCQA allows delegation of primary source verification to a certified CVO, which meets the standard without the organization repeating the process.

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS Primary Source Verification 4