CPCS Reappointment and Recredentialing 4

Question 1

An organization uses a 'clean file' exception to expedite reappointment for providers with no adverse findings. Which criterion would DISQUALIFY a provider from the clean file process?

Accepted Answer

A single unresolved patient complaint under investigation

Answer

An open or unresolved complaint or investigation disqualifies a provider from the expedited clean file process requiring full committee review.

Question 2

Which of the following BEST describes the relationship between OPPE and recredentialing?

Accepted Answer

OPPE data informs the credentials committee's reappointment decision

Answer

OPPE provides ongoing performance data that the credentials committee uses as evidence when making reappointment decisions.

Question 3

A provider's reappointment file is complete except for one outstanding reference letter. The privilege period expires in five days. What is the most appropriate action?

Accepted Answer

Contact the reference directly to expedite the letter and follow the organization's incomplete application policy

Answer

The credentialing staff should actively pursue the missing reference and apply the organization's policy for incomplete applications to prevent a privilege lapse.

Question 4

A credentials committee member has a financial relationship with a provider whose reappointment is being reviewed. What must this committee member do?

Accepted Answer

Recuse themselves from the discussion and vote on that provider's reappointment

Answer

A committee member with a conflict of interest must recuse themselves from all deliberation and voting on that provider's reappointment.

Question 5

An organization learns mid-cycle that a provider's Drug Enforcement Administration (DEA) registration was revoked. Which action is required IMMEDIATELY?

Accepted Answer

Initiate a summary suspension of DEA-controlled substance prescribing privileges pending investigation

Answer

DEA revocation requires immediate restriction of controlled substance prescribing authority pending a full investigation to protect patient safety.

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS Reappointment and Recredentialing 4