CPCS Study Guide Practice Test
Questions and Answers
Why it is important to check that the practitioner is not currently excluded, suspended,
debarred, or ineligible to participate in Federal health care programs? - ANSWER-The
facility won't get paid for treating patients unless service is provided by authorized
provider.
Which of the following credentials must be tracked on an ongoing basis? - ANSWER-
Licensure
According to NCQA standards, an organization that discovers sanction information,
complaints, or adverse events regarding a practitioner must take what action? -
ANSWER-Determine if there is evidence of poor quality that could affect the health and
safety of its members.
What is the name of the entity that was established through the Health Care Quality
Improvement Act of 1986 to restrict the ability of incompetent physicians, dentists, and
other health care practitioners to move from state to state without disclosure or
discovery of previous medical malpractice payment and adverse action history? -
ANSWER-The National Practitioner Data Bank
When developing clinical privileging criteria, which of the following is important to
evaluate? - ANSWER-Established standards of practice, such as specialty board
recommendations.
What is the main reason for periodically assessing appropriateness of clinical privileges
for each specialty? - ANSWER-It is required by the Medicare Conditions of
Participation.
Which of the following specialists is most likely to perform a PTCA? - ANSWER-
Interventional Cardiologist
The Joint Commission hospital standards require that clinical privileges are hospital
specific and - ANSWER-Based on the individual's demonstrated current competence
and the procedures the hospital can support.
Which of the following would be routinely performed by a cardiologist? - ANSWER-
Transesophageal Echocardiography
, Which NCQA-required committee makes recommendations regarding credentialing
decisions? - ANSWER-Credentialing Committee
HFAP standards require three medical staff committees to be delineated in the medical
staff structure. Two of them are the Medical Executive Committee and the Utilization of
Osteopathic Methods & Concepts Committee (required for hospitals with ten or more
DOs who admit patients and provide direct patient care). What is the other required
medical staff committee? - ANSWER-Utilization Review Committee
How often does NCQA require that delegation reports be evaluated by the health plan?
- ANSWER-Semi-Annually
Peer references should be obtained from: - ANSWER-Practitioners in the same
professional discipline as the applicant
NCQA recognizes which of the following as the final approval of an applicant who does
not meet criteria for a clean file? - ANSWER-Credentialing Committee
If a medical staff member has privileges and/or medical staff appointment revoked,
he/she must be: - ANSWER-Provided due process.
Access to credentials files should be: - ANSWER-Described fully in an access policy.
Which of the following bodies approves clinical privileges? - ANSWER-Governing Body
or Board
What primary source verification is required by NCQA prior to provisional credentialing?
- ANSWER-Licensure and 5-year malpractice history or NPDB
According to The Joint Commission standards, initial appointments to the medical staff
are made for a period of: - ANSWER-Not to exceed two years
According to The Joint Commission standards, temporary privileges may be granted by:
- ANSWER-The CEO on the recommendation of the medical staff president or
authorized designee
According to The Joint Commission Standards, which of the following items must be
verified with a primary source? - ANSWER-Licensure, training, experience, and
competence
According to NCQA standards, a copy of which of the following is acceptable verification
of the document? - ANSWER-DEA certificate
According to NCQA standards, which is an acceptable source for primary source
verification of Medicare and Medicaid sanction activity against physicians? - ANSWER-
Federation of State Medical Boards
Questions and Answers
Why it is important to check that the practitioner is not currently excluded, suspended,
debarred, or ineligible to participate in Federal health care programs? - ANSWER-The
facility won't get paid for treating patients unless service is provided by authorized
provider.
Which of the following credentials must be tracked on an ongoing basis? - ANSWER-
Licensure
According to NCQA standards, an organization that discovers sanction information,
complaints, or adverse events regarding a practitioner must take what action? -
ANSWER-Determine if there is evidence of poor quality that could affect the health and
safety of its members.
What is the name of the entity that was established through the Health Care Quality
Improvement Act of 1986 to restrict the ability of incompetent physicians, dentists, and
other health care practitioners to move from state to state without disclosure or
discovery of previous medical malpractice payment and adverse action history? -
ANSWER-The National Practitioner Data Bank
When developing clinical privileging criteria, which of the following is important to
evaluate? - ANSWER-Established standards of practice, such as specialty board
recommendations.
What is the main reason for periodically assessing appropriateness of clinical privileges
for each specialty? - ANSWER-It is required by the Medicare Conditions of
Participation.
Which of the following specialists is most likely to perform a PTCA? - ANSWER-
Interventional Cardiologist
The Joint Commission hospital standards require that clinical privileges are hospital
specific and - ANSWER-Based on the individual's demonstrated current competence
and the procedures the hospital can support.
Which of the following would be routinely performed by a cardiologist? - ANSWER-
Transesophageal Echocardiography
, Which NCQA-required committee makes recommendations regarding credentialing
decisions? - ANSWER-Credentialing Committee
HFAP standards require three medical staff committees to be delineated in the medical
staff structure. Two of them are the Medical Executive Committee and the Utilization of
Osteopathic Methods & Concepts Committee (required for hospitals with ten or more
DOs who admit patients and provide direct patient care). What is the other required
medical staff committee? - ANSWER-Utilization Review Committee
How often does NCQA require that delegation reports be evaluated by the health plan?
- ANSWER-Semi-Annually
Peer references should be obtained from: - ANSWER-Practitioners in the same
professional discipline as the applicant
NCQA recognizes which of the following as the final approval of an applicant who does
not meet criteria for a clean file? - ANSWER-Credentialing Committee
If a medical staff member has privileges and/or medical staff appointment revoked,
he/she must be: - ANSWER-Provided due process.
Access to credentials files should be: - ANSWER-Described fully in an access policy.
Which of the following bodies approves clinical privileges? - ANSWER-Governing Body
or Board
What primary source verification is required by NCQA prior to provisional credentialing?
- ANSWER-Licensure and 5-year malpractice history or NPDB
According to The Joint Commission standards, initial appointments to the medical staff
are made for a period of: - ANSWER-Not to exceed two years
According to The Joint Commission standards, temporary privileges may be granted by:
- ANSWER-The CEO on the recommendation of the medical staff president or
authorized designee
According to The Joint Commission Standards, which of the following items must be
verified with a primary source? - ANSWER-Licensure, training, experience, and
competence
According to NCQA standards, a copy of which of the following is acceptable verification
of the document? - ANSWER-DEA certificate
According to NCQA standards, which is an acceptable source for primary source
verification of Medicare and Medicaid sanction activity against physicians? - ANSWER-
Federation of State Medical Boards
