CPCS CPCS - Certified Provider Credentialing Specialist Ongoing Monitoring and Audits Questions and Answers 2

Question 1

How frequently must organizations participating in the Medicare and Medicaid programs check practitioners against the OIG List of Excluded Individuals/Entities (LEIE)?

Accepted Answer

At least monthly, per OIG guidance

Answer

The OIG recommends that healthcare organizations check the LEIE at least monthly to ensure no currently participating practitioners or employees are excluded from federal healthcare programs.

Question 2

During a credentialing audit, a surveyor finds that OPPE reports have not been provided to practitioners at any point during the past 18 months. Under TJC standards, this would be considered which type of deficiency?

Accepted Answer

A Requirement for Improvement (RFI)

Answer

Failure to conduct OPPE at the required interval (at least every 6 months) would be cited as a Requirement for Improvement under TJC standards, requiring submission of an Evidence of Standards Compliance.

Question 3

An organization is implementing continuous monitoring for its practitioner network. Which database should be checked to identify practitioners who have had DEA registration revoked or surrendered?

Accepted Answer

The DEA Diversion Control Division website

Answer

DEA registration actions (revocation, suspension, surrender) can be verified through the DEA Diversion Control Division website or by contacting the DEA directly, in addition to NPDB which also receives DEA adverse action reports.

Question 4

What is the primary purpose of conducting a 'focused audit' of credentialing files?

Accepted Answer

To identify specific compliance gaps or areas needing improvement in the credentialing process

Answer

Focused audits target specific elements or processes in the credentialing program to identify compliance gaps, assess adherence to policies, and identify areas for process improvement.

Question 5

A credentialing manager is developing a quality dashboard for the credentialing program. Which of the following metrics would best measure the efficiency of the initial credentialing process?

Accepted Answer

Average number of days from completed application receipt to committee approval

Answer

Average processing time from completed application to committee approval directly measures the efficiency of the initial credentialing workflow and can be benchmarked against industry standards and accreditation requirements.

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS CPCS - Certified Provider Credentialing Specialist Ongoing Monitoring and Audits Questions and Answers 2