CPCS Primary Source Verification 5 — Questions and Answers
Question 1: A provider's state license has been verified but shows a restriction limiting their scope of practice. What is the MOST appropriate action?
- Deny all privileges to the provider
- Grant full privileges since the license is active
- Report the restriction to the credentialing committee for privilege delineation (Correct answer)
- Ask the provider to apply for an unrestricted license before proceeding
Correct answer: Report the restriction to the credentialing committee for privilege delineation
License restrictions directly affect privilege delineation and must be reviewed by the credentialing committee to ensure privileges align with allowed practice.
Question 2: In the context of primary source verification, what is the significance of a 'deemed status' organization?
- It means the organization is exempt from all credentialing requirements
- It indicates the organization's accreditation meets or exceeds CMS standards, reducing duplicative verification (Correct answer)
- It signifies the provider has been pre-approved for privileges
- It means the organization can skip NPDB queries
Correct answer: It indicates the organization's accreditation meets or exceeds CMS standards, reducing duplicative verification
Deemed status means CMS has determined the accrediting body's standards are equivalent to or more stringent than CMS Conditions of Participation.
Question 3: How long must credentialing files be retained according to standard best practices and most state regulations?
- 2 years
- 5 years
- 7 years (Correct answer)
- 10 years
Correct answer: 7 years
Most state regulations and accreditation standards recommend retaining credentialing files for a minimum of seven years.
Question 4: Which scenario represents an appropriate use of 'credentials by proxy' during primary source verification?
- Accepting a photocopy of a license from the provider
- Using verification completed by another accredited hospital within the past 180 days (Correct answer)
- Asking a colleague to verify a provider's credentials verbally
- Relying on a staffing agency's background check
Correct answer: Using verification completed by another accredited hospital within the past 180 days
Some accreditation bodies allow acceptance of verification previously completed by another accredited facility within a defined timeframe as 'credentials by proxy.'
Question 5: A provider claims to have passed a board examination but the certifying board has no record of the provider. What does this most likely indicate?
- An administrative error by the certifying board
- A potential falsification of credentials requiring committee review (Correct answer)
- The board certification has simply expired
- The provider trained under a different name
Correct answer: A potential falsification of credentials requiring committee review
When a primary source cannot confirm a claimed credential, it raises a material discrepancy that must be escalated to the credentialing committee as potential falsification.
Question 6: Under CMS regulations, which type of practitioner is NOT required to undergo primary source verification before providing services?
- Nurse practitioners
- Telemedicine providers from another state
- Emergency locum tenens physicians under 60 days (Correct answer)
- Dentists performing hospital procedures
Correct answer: Emergency locum tenens physicians under 60 days
CMS allows hospitals to grant emergency privileges to locum tenens practitioners for up to 60 days without completing full primary source verification, using an expedited process.
Question 7: Which best practice should be followed when a provider's license number on their application does not match the number found through primary source verification?
- Assume a typographical error and proceed with the verified number
- Document the discrepancy, request clarification from the provider, and escalate if unresolved (Correct answer)
- Deny the application immediately for providing false information
- Contact the state board to request they update their records
Correct answer: Document the discrepancy, request clarification from the provider, and escalate if unresolved
Any discrepancy between application data and primary source findings must be documented, the provider given opportunity to explain, and unresolved issues escalated per policy.
CPCS Primary Source Verification 5
A provider's state license has been verified but shows a restriction limiting their scope of practice.
What is the MOST appropriate action?