FREE CPCS Provider Enrollment and Payer Credentialing Processes Questions and Answers

Question 1

What is the primary function of the Council for Affordable Quality Healthcare (CAQH) ProView platform in the payer credentialing process?

Accepted Answer

It serves as a single, centralized online data repository for providers to submit and maintain their credentialing information.

Answer

It performs primary source verification of all provider credentials.

Answer

It is a government agency that issues National Provider Identifiers (NPIs).

Answer

It directly negotiates reimbursement rates between providers and payers.

Question 2

A National Provider Identifier (NPI) is a unique 10-digit identification number required by HIPAA for all healthcare providers. Who issues the NPI?

Accepted Answer

The Centers for Medicare & Medicaid Services (CMS).

Answer

The American Medical Association (AMA).

Answer

The Drug Enforcement Administration (DEA).

Answer

The Federation of State Medical Boards (FSMB).

Question 3

When enrolling a new physician in Medicare, which form is typically used for an individual practitioner?

Accepted Answer

CMS-855I

Answer

CMS-855B

Answer

CMS-855R

Answer

UB-04

Question 4

A physician joins a practice on July 1st. The Medicare enrollment application is submitted on July 20th and the effective date is determined to be July 1st. This is an example of:

Accepted Answer

Retroactive billing.

Answer

Provider fraud.

Answer

Locum tenens billing.

Answer

Incident-to billing.

Question 5

A large medical group has a 'delegated credentialing' agreement with a health plan. What does this mean?

Accepted Answer

The medical group is responsible for performing credentialing functions on behalf of the health plan, subject to the plan's audit.

Answer

The health plan no longer needs to credential any providers from that group.

Answer

The medical group can decide which providers the health plan must accept into its network.

Answer

The provider can start billing the health plan before any credentialing is completed.

Question 6

The process by which Medicare requires providers to periodically resubmit and recertify the accuracy of their enrollment information is called:

Accepted Answer

Revalidation.

Answer

Reappointment.

Answer

Re-enrollment.

Answer

Re-attestation.

Question 7

What is the most significant financial consequence of delays in the provider enrollment and payer credentialing process?

Accepted Answer

Delayed or lost revenue due to the inability to bill for a new provider's services.

Answer

Increased administrative staff overtime pay.

Answer

Fines from state regulatory agencies.

Answer

Poor patient satisfaction scores.