CPCS Exam Questions with Verified Correct
Answers
Appointment Timeframe - TJC
Not to exceed two years
Appointment Timeframe - NCQA
Recredential at least every 3 years.
Cycle to the month.
Appointment Timeframe - HFAP
At least every 24 months
Appointment Timeframe - DNV
Not to exceed 3 years
Appointment Timeframe - URAC
At least every 3 years
Cycle to the month
Appointment Timeframe - AAAHC
Not to exceed 3 years
Appointment Timeframe - CMS
Practitioner - at least every 24 months
Surgery - every two years
Attestation Statement Timeframe - NCQA
,365 days from final approval
305 - CVO
Attestation Statement Timeframe - URAC
180 days prior to credentials committee review
Doesn't require attestation statement
TJC, DNV, CoPs
Board Certification Time Limit - NCQA
180 days
120 days CVO
Board Certification Time Limit - URAC
6 months
Board Certification Verification Required at Recredentialing by
NCQA - verification
HFAP - review
AAAHC
What is typically monitored for expiration?
Board certification
License (loss of license, sanctions) - NCQA
DEA - AAAHC
Board Certification Verification Required at Initial and Expiration by
URAC
,PSV for Board Certification
ABMS, AMA, AOA
State licensing agency if confirmation that agency conducts PSV of board status
Confirmation from board
NCQA Approved Source: requirement for verifying source completes PSV
Organization verifies source performs PSV
At least annually organization obtains written confirmation that source performs PSV
QAPI
Medicare CoPs require periodical appraisals of members through Quality Assessment
Performance Improvement (QAPI) process
must include complaints regarding medical staff-related issues
Complaints evaluation - NCQA
Evaluate history of complaints for all practitioners at least every 6 months
CME not addressed by
NCQA, URAC, AAAHC, CoPs
Evaluation of CVO - TJC
9 principles
Data & Info available
processes utilized
limitations of info
identification of primary source vs. secondary source
quality control measures related to data integrity, security, transmission, etc.
, Criminal Background Check - HFAP
Application requests criminal history information for 7 - 10 years
Facility conducts background investigation as required
Criminal Background Check required by
TJC, HFAP
FSMB
Federation of State Medical Boards
all actions against a physician's medical licesnse
used by TJC, HFAP
Disciplinary actions: state licensing agency, board actions, or if physician is clean.
Disciplinary alert service: notification for report of MD, DO, or PA
NPDB information available:
Medical malpractice payments
Adverse licensure action
Dismissal or closure of proceedings
Adverse clinical privileging actions
Adverse professional society membership
Negative action or finding by State licensing or certification authority
Peer review negative findings
Adverse actions against DEA certification
Medicare Exclusion
Education & Residency/post-grad Verification Sources
Answers
Appointment Timeframe - TJC
Not to exceed two years
Appointment Timeframe - NCQA
Recredential at least every 3 years.
Cycle to the month.
Appointment Timeframe - HFAP
At least every 24 months
Appointment Timeframe - DNV
Not to exceed 3 years
Appointment Timeframe - URAC
At least every 3 years
Cycle to the month
Appointment Timeframe - AAAHC
Not to exceed 3 years
Appointment Timeframe - CMS
Practitioner - at least every 24 months
Surgery - every two years
Attestation Statement Timeframe - NCQA
,365 days from final approval
305 - CVO
Attestation Statement Timeframe - URAC
180 days prior to credentials committee review
Doesn't require attestation statement
TJC, DNV, CoPs
Board Certification Time Limit - NCQA
180 days
120 days CVO
Board Certification Time Limit - URAC
6 months
Board Certification Verification Required at Recredentialing by
NCQA - verification
HFAP - review
AAAHC
What is typically monitored for expiration?
Board certification
License (loss of license, sanctions) - NCQA
DEA - AAAHC
Board Certification Verification Required at Initial and Expiration by
URAC
,PSV for Board Certification
ABMS, AMA, AOA
State licensing agency if confirmation that agency conducts PSV of board status
Confirmation from board
NCQA Approved Source: requirement for verifying source completes PSV
Organization verifies source performs PSV
At least annually organization obtains written confirmation that source performs PSV
QAPI
Medicare CoPs require periodical appraisals of members through Quality Assessment
Performance Improvement (QAPI) process
must include complaints regarding medical staff-related issues
Complaints evaluation - NCQA
Evaluate history of complaints for all practitioners at least every 6 months
CME not addressed by
NCQA, URAC, AAAHC, CoPs
Evaluation of CVO - TJC
9 principles
Data & Info available
processes utilized
limitations of info
identification of primary source vs. secondary source
quality control measures related to data integrity, security, transmission, etc.
, Criminal Background Check - HFAP
Application requests criminal history information for 7 - 10 years
Facility conducts background investigation as required
Criminal Background Check required by
TJC, HFAP
FSMB
Federation of State Medical Boards
all actions against a physician's medical licesnse
used by TJC, HFAP
Disciplinary actions: state licensing agency, board actions, or if physician is clean.
Disciplinary alert service: notification for report of MD, DO, or PA
NPDB information available:
Medical malpractice payments
Adverse licensure action
Dismissal or closure of proceedings
Adverse clinical privileging actions
Adverse professional society membership
Negative action or finding by State licensing or certification authority
Peer review negative findings
Adverse actions against DEA certification
Medicare Exclusion
Education & Residency/post-grad Verification Sources
