CPCS Reappointment and Recredentialing 5

Question 1

A provider who holds privileges at two hospitals within the same health system is being recredentialed. The system uses a centralized credentials verification organization (CVO). How does this affect the recredentialing process?

Accepted Answer

The CVO performs primary source verification once and shares results with both hospitals, which each make independent appointment decisions

Answer

A CVO centralizes primary source verification, but each medical staff organization retains authority over its own appointment and privileging decisions.

Question 2

During recredentialing, a provider's specialty board certification has lapsed. The organization requires board certification for that specialty. What is the most appropriate credential committee action?

Accepted Answer

Evaluate whether the provider meets alternative criteria per the medical staff bylaws and set a timeline for recertification

Answer

The committee should assess whether the bylaws provide alternative criteria for providers whose certification has lapsed and establish a timeline for reinstatement.

Question 3

A hospital receives a request from an insurer to verify that a physician is on the medical staff in good standing as part of the insurer's credentialing process. What should the hospital do?

Accepted Answer

Confirm or deny medical staff membership and good standing status only, with the physician's consent

Answer

Hospitals may confirm medical staff status and good standing with provider consent but should not release detailed credentialing file contents.

Question 4

Which scenario MOST likely triggers a mandatory NPDB query outside of the standard reappointment cycle?

Accepted Answer

A provider requests additional privileges

Answer

Requests for new or additional privileges require an NPDB query because they constitute a new privileging action.

Question 5

A credentialing specialist notes that a provider's reappointment file contains OPPE data showing below-average outcomes in one specific procedure. What is the MOST appropriate next step?

Accepted Answer

Flag the finding for the credentials committee to consider initiating FPPE for that specific procedure

Answer

Below-average OPPE data for a specific procedure should be flagged for the credentials committee to consider whether FPPE is warranted for that competency area.

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS Reappointment and Recredentialing 5