NAMSS CPCS Participation Guide UPDATED ACTUAL Exam Questions and CORRECT Answers

NAMSS CPCS Participation Guide
UPDATED ACTUAL Exam Questions and
CORRECT Answers
Hospital Credentialing Driven by: - CORRECT ANSWER - - Federal/State Regulations
- CMS
- Hospital CoPs
- HCQIA
- Accreditation Standards
- TJC
- HFAP
- DNV
-Bylaws, Rules and Regs
-Standard of Care (legal aspect)


Managed Care Org Credentialing Driven by: - CORRECT ANSWER - -Federal/State
Regulations
-Policies and Procedures
-Accreditation Standards (NCQA, URAC)
-Standard of Care (legal aspect)
-HEDIS/CAHPS


MCO Organization Chart - CORRECT ANSWER - Director of Managed Care
Contracts Management --> Client Services
Financial Management --->Network Administration


CVO Organizational Chart - CORRECT ANSWER - (depending on size)
Director ---> Contract sales/Credentialing Staff/Human Resources

, CVO Credentialing Driven by: - CORRECT ANSWER - - Contract
- Accredidation Standards (NCQA, URAC,TJC,AAAHC, CMS, HFAP & DNV)
-Policies and Procedures


Ambulatory Care/Medical Office/Surgical Center Credentialing Driven by: - CORRECT
ANSWER - - Accreditation Standards (AAAHC, TJC, NCQA)
- CMS Regulations
- State law
- Policies and Procedures
- Contractual Agreements


What is hospital credentialing driven by? - CORRECT ANSWER - - Federal/State
Regulations
- CMS
- Hospital CoPs
- HCQIA
- Accreditation Standards
- TJC
- HFAP
- DNV
-Bylaws, Rules and Regs
-Standard of Care (legal aspect)


Difference between an Independant CVO vs. Organization CVO? - CORRECT
ANSWER - Independant CVO contracts with many outside organizations. Typically for-
profit company.
Organization CVO handles org specific credentialing; part of the not-for-profit org. May be for-
profit and have customers outside of the org.