CPCS/CPMSM Exam 2026 Questions
and Answers
Applicant completes an application that includes, reasons for inability to perform,
las of present illegal drug use, loss of license or felony convictions. Loss or
limitation of privileges or disciplinary actions. Current malpractice insurance
coverage, current signed attestation confirming the correctness and completeness
of the application. If an application from an external entity is used it must include
the questions and attestations as identified above. Signature stamps are not
acceptable unless the practitioner is physically impaired and the disability is
documented in the practitioners file. - Answer -NCQA Health Plan/CVO
Which type of agenda is used on a meeting agenda to group together non-
controversial business and reports that can be approved under one motion instead
of individually approving each item? - Answer -Consent Agenda
According to NCQA under what circumstance would a Locum Tenens practitioner
be exempt from credentialing? - Answer -Covering Practitioner
According to URAC, when developing a quality auditing process, prudent practice
would be to audit what percentage of completed credentialing files? - Answer -
©COPYRIGHT 2025, ALL RIGHTS RESERVED 1
,According to URAC, a complete credentials file should be reviewed by which
professionals? - Answer -
According to NCQA, what must be included in the organization's right to appeal
policies? - Answer -written notification when a professional review action has been
brought against a practitioner
reasons for the action
summary of the appeal rights and process
ability to request a hearing and the specific time period for submitting the request
allowing for at least 30 calendar days after the notification for practitioners to
request a hearing
allowing representation by an attorney or another person
appointment of a hearing officer or a panel of individuals to review the appeal
and written notification of the appeal decision that contains specific reasons for the
decision.
Which Accrediting body requires an attestation to the practitioners identity? -
Answer -The Joint Commission
According to HFAP, how often must a reappraisal of membership and privileges
occur? - Answer -Every 24 months
©COPYRIGHT 2025, ALL RIGHTS RESERVED 2
,Which Accrediting Agency requires all practitioners with clinical privileges to
participate in continuing education? - Answer -DNV
According to CMS, what criteria are used by the governing board for the selection
of medical staff members? - Answer -Character, competence, training, experience,
and judgment
Which agency requires peer recommendations be obtained at initial credentialing
and reappointment? - Answer -AAAHC
Which regulatory agency standards must be followed for a hospital to bill for
Medicare/Medicaid services? - Answer -CMS Conditions of Participation
Which Federal legislation created the National Practitioner Data Bank? - Answer -
HCQIA
According to TJC, what is required to make a recommendation to the Governing
Board? - Answer -Medical Executive Committee
According to NCQA, the application process is located in what document? -
Answer -
Why it is important to check that the practitioner is not currently excluded,
suspended, debarred, or ineligible to
©COPYRIGHT 2025, ALL RIGHTS RESERVED 3
, participate in Federal health care programs? - Answer -The facility won't get paid
for treating patients unless service is provided by authorized provider.
Which credential 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 -NPDB
When developing clinical privileging criteria, what is important to evaluate? -
Answer -Established standards of practice such as, specialty board
recommendations.
©COPYRIGHT 2025, ALL RIGHTS RESERVED 4
and Answers
Applicant completes an application that includes, reasons for inability to perform,
las of present illegal drug use, loss of license or felony convictions. Loss or
limitation of privileges or disciplinary actions. Current malpractice insurance
coverage, current signed attestation confirming the correctness and completeness
of the application. If an application from an external entity is used it must include
the questions and attestations as identified above. Signature stamps are not
acceptable unless the practitioner is physically impaired and the disability is
documented in the practitioners file. - Answer -NCQA Health Plan/CVO
Which type of agenda is used on a meeting agenda to group together non-
controversial business and reports that can be approved under one motion instead
of individually approving each item? - Answer -Consent Agenda
According to NCQA under what circumstance would a Locum Tenens practitioner
be exempt from credentialing? - Answer -Covering Practitioner
According to URAC, when developing a quality auditing process, prudent practice
would be to audit what percentage of completed credentialing files? - Answer -
©COPYRIGHT 2025, ALL RIGHTS RESERVED 1
,According to URAC, a complete credentials file should be reviewed by which
professionals? - Answer -
According to NCQA, what must be included in the organization's right to appeal
policies? - Answer -written notification when a professional review action has been
brought against a practitioner
reasons for the action
summary of the appeal rights and process
ability to request a hearing and the specific time period for submitting the request
allowing for at least 30 calendar days after the notification for practitioners to
request a hearing
allowing representation by an attorney or another person
appointment of a hearing officer or a panel of individuals to review the appeal
and written notification of the appeal decision that contains specific reasons for the
decision.
Which Accrediting body requires an attestation to the practitioners identity? -
Answer -The Joint Commission
According to HFAP, how often must a reappraisal of membership and privileges
occur? - Answer -Every 24 months
©COPYRIGHT 2025, ALL RIGHTS RESERVED 2
,Which Accrediting Agency requires all practitioners with clinical privileges to
participate in continuing education? - Answer -DNV
According to CMS, what criteria are used by the governing board for the selection
of medical staff members? - Answer -Character, competence, training, experience,
and judgment
Which agency requires peer recommendations be obtained at initial credentialing
and reappointment? - Answer -AAAHC
Which regulatory agency standards must be followed for a hospital to bill for
Medicare/Medicaid services? - Answer -CMS Conditions of Participation
Which Federal legislation created the National Practitioner Data Bank? - Answer -
HCQIA
According to TJC, what is required to make a recommendation to the Governing
Board? - Answer -Medical Executive Committee
According to NCQA, the application process is located in what document? -
Answer -
Why it is important to check that the practitioner is not currently excluded,
suspended, debarred, or ineligible to
©COPYRIGHT 2025, ALL RIGHTS RESERVED 3
, participate in Federal health care programs? - Answer -The facility won't get paid
for treating patients unless service is provided by authorized provider.
Which credential 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 -NPDB
When developing clinical privileging criteria, what is important to evaluate? -
Answer -Established standards of practice such as, specialty board
recommendations.
©COPYRIGHT 2025, ALL RIGHTS RESERVED 4
