CPCS - Certified Provider Credentialing Specialist Primary Source Verification Questions and Answers

Question 1

A credentialing specialist is verifying a physician's records for a hospital's initial appointment. Which of the following is considered an acceptable primary source for verifying a medical school diploma?

Accepted Answer

A written confirmation directly from the medical school's registrar's office.

Answer

Primary Source Verification (PSV) requires verifying credentials directly from the issuing source. In this case, the medical school that issued the diploma is the primary source. The AMA Physician Masterfile is a designated equivalent source, but direct confirmation from the school is the most direct primary source.

Question 2

According to The Joint Commission (TJC) standards, which of the following credentials requires Primary Source Verification at the time of initial appointment and at reappointment?

Accepted Answer

State medical license

Answer

The Joint Commission mandates that licensure, which is required by law or regulation to practice a profession, must be verified directly from the issuing authority (the state licensing board) at several key times, including initial appointment and reappointment.

Question 3

A managed care organization's credentialing department is reviewing a new provider application. To comply with NCQA standards, which source would be unacceptable for the primary source verification of board certification?

Accepted Answer

A notarized copy of the board certificate provided by the applicant.

Answer

NCQA standards require verification of board certification to come directly from the primary source or a designated equivalent. A copy provided by the applicant, even if notarized, is not a primary source. Acceptable sources include ABMS, AOA, and the specific issuing board.

Question 4

During a credentialing audit, a specialist discovers a six-month gap in a physician's work history on their application. What is the most appropriate next step according to NCQA guidelines?

Accepted Answer

Request a signed attestation from the provider explaining the gap.

Answer

NCQA standards require that gaps in work history of more than six months must be explained by the provider. The standard procedure is to obtain a written and signed explanation from the applicant.

Question 5

Which of the following is the primary purpose of conducting Primary Source Verification (PSV) in the healthcare credentialing process?

Accepted Answer

To protect patient safety and ensure regulatory compliance.

Answer

The fundamental reason for PSV is to ensure that healthcare professionals are qualified and competent, which directly impacts patient safety. It also ensures the organization complies with accreditation and regulatory standards.

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS - Certified Provider Credentialing Specialist Primary Source Verification Questions and Answers