CPCS Exam 318 Questions and Answers (2025/2026) with Complete
Solutions
Question 1
According to NCQA Standards, which of the following documents is acceptable as a copy for
certification purposes?
A) State medical license
B) DEA certificate
C) Medical school diploma
D) Malpractice insurance face sheet
E) Board certification
Correct Answer: C) Medical school diploma
Rationale: NCQA allows for a copy of the medical school diploma to be accepted for
certification. Most other critical credentials, such as licensure and board certification,
require primary source verification.
Question 2
Which of the following accreditation bodies have specific standards related to the documentation
and confidentiality of medical records?
A) NCQA and URAC only
B) The Joint Commission (JC) and NCQA
C) AAAHC and CMS only
D) JC and HFAP only
E) URAC and AAAHC only
Correct Answer: B) The Joint Commission (JC) and NCQA
Rationale: Both The Joint Commission, which accredits hospitals and other healthcare
organizations, and NCQA, which accredits managed care organizations, have
comprehensive standards addressing the content, maintenance, and confidentiality of
patient medical records.
Question 3
Which of the following motions are classified as subsidiary motions in parliamentary procedure?
A) Adjourn, Recess, Question of Privilege
B) Point of Order, Appeal, Suspend the Rules
,[Type here]
C) Main Motion, Reconsider, Rescind
D) Lay on the table, Previous Question (end debate), Commit or Refer
E) Take from the Table, Discharge a Committee
Correct Answer: D) Lay on the table, Previous Question (end debate), Commit or Refer
Rationale: Subsidiary motions are used to modify or dispose of a main motion. They include
motions to postpone, commit (refer to a committee), amend, limit or extend debate, and the
previous question (end debate and vote).
Question 4
According to NCQA standards for verifying a DEA certificate at the time of initial credentialing,
what is the permitted timeframe for verification?
A) Must be verified within 180 days of the committee review.
B) Must be verified within 365 days of the committee review.
C) There is no timeframe, as long as it is current at the time of the credentials committee review.
D) Must be verified directly from the DEA within 120 days.
E) Verification is only required at recredentialing.
Correct Answer: C) There is no timeframe, as long as it is current at the time of the
credentials committee review.
Rationale: Unlike some other credentials that have a specific verification "look-back"
period, NCQA requires that the DEA or CDS certificate be verified as current and valid at
the time the credentialing decision is made.
Question 5
According to URAC standards, primary source verification (PSV) or secondary PSV of a
credential may not be collected more than how many months prior to the Credentialing
Committee review?
A) 3 months
B) 6 months
C) 9 months
D) 12 months
E) 24 months
,[Type here]
Correct Answer: B) 6 months
Rationale: URAC specifies that credentialing information must be timely. It sets a limit that
verifications cannot be older than six months at the time the credentialing committee
makes its decision.
Question 6
Does NCQA require a hospital to credential a locum tenens physician who is working in an
independent relationship within the inpatient setting?
A) Yes, if they work for more than 30 days.
B) Yes, all physicians must be credentialed.
C) No, NCQA standards do not require locum tenens to be credentialed in this setting.
D) No, only The Joint Commission requires this.
E) Yes, but only if they are not board certified.
Correct Answer: C) No, NCQA standards do not require locum tenens to be credentialed in
this setting.
Rationale: NCQA's credentialing standards do not apply to practitioners who practice
exclusively within an inpatient setting. Therefore, a locum tenens physician working only in
the hospital would not fall under the NCQA requirement for the health plan to credential
them.
Question 7
The professional practice questions on an application, as required by NCQA, must ask about
which of the following?
A) The applicant's financial history.
B) The correctness and completeness of the application and lack of present illegal drug use.
C) Voluntary relinquishment of privileges for non-quality reasons.
D) Any malpractice claims that did not result in a settlement.
E) The applicant's age and marital status.
Correct Answer: B) The correctness and completeness of the application and lack of present
illegal drug use.
Rationale: NCQA requires a signed attestation that addresses several key areas, including
, [Type here]
the lack of present illegal drug use and a statement that the application is correct and
complete.
Question 8
When evaluating a practitioner for privileges, The Joint Commission (JC) requires the
application to ask about which of the following?
A) The applicant's history of felony convictions.
B) The applicant's current malpractice insurance coverage.
C) Voluntary and involuntary limitation, reduction, or loss of clinical privileges.
D) The applicant's ability to perform the essential functions of the position.
E) Any history of illegal drug use.
Correct Answer: C) Voluntary and involuntary limitation, reduction, or loss of clinical
privileges.
Rationale: The Joint Commission places a strong emphasis on current competence and past
performance. It specifically requires organizations to inquire about any previous loss or
limitation of privileges at other facilities, as this is a key indicator of potential quality or
conduct issues.
Question 9
According to NCQA, when an organization delegates credentialing activities to another entity,
the written delegation document must:
A) Be renewed on a monthly basis.
B) Describe the delegated activities and the responsibilities of both parties.
C) Be approved by the state medical board.
D) Be signed by every practitioner being credentialed.
E) Be made available to the public upon request.
Correct Answer: B) Describe the delegated activities and the responsibilities of both parties.
Rationale: NCQA allows for delegation but requires strict oversight. The foundation of this
oversight is a formal, mutually agreed-upon document that clearly outlines the scope of the
delegated activities, the reporting requirements, and the responsibilities of both the
organization and the delegated entity.
Solutions
Question 1
According to NCQA Standards, which of the following documents is acceptable as a copy for
certification purposes?
A) State medical license
B) DEA certificate
C) Medical school diploma
D) Malpractice insurance face sheet
E) Board certification
Correct Answer: C) Medical school diploma
Rationale: NCQA allows for a copy of the medical school diploma to be accepted for
certification. Most other critical credentials, such as licensure and board certification,
require primary source verification.
Question 2
Which of the following accreditation bodies have specific standards related to the documentation
and confidentiality of medical records?
A) NCQA and URAC only
B) The Joint Commission (JC) and NCQA
C) AAAHC and CMS only
D) JC and HFAP only
E) URAC and AAAHC only
Correct Answer: B) The Joint Commission (JC) and NCQA
Rationale: Both The Joint Commission, which accredits hospitals and other healthcare
organizations, and NCQA, which accredits managed care organizations, have
comprehensive standards addressing the content, maintenance, and confidentiality of
patient medical records.
Question 3
Which of the following motions are classified as subsidiary motions in parliamentary procedure?
A) Adjourn, Recess, Question of Privilege
B) Point of Order, Appeal, Suspend the Rules
,[Type here]
C) Main Motion, Reconsider, Rescind
D) Lay on the table, Previous Question (end debate), Commit or Refer
E) Take from the Table, Discharge a Committee
Correct Answer: D) Lay on the table, Previous Question (end debate), Commit or Refer
Rationale: Subsidiary motions are used to modify or dispose of a main motion. They include
motions to postpone, commit (refer to a committee), amend, limit or extend debate, and the
previous question (end debate and vote).
Question 4
According to NCQA standards for verifying a DEA certificate at the time of initial credentialing,
what is the permitted timeframe for verification?
A) Must be verified within 180 days of the committee review.
B) Must be verified within 365 days of the committee review.
C) There is no timeframe, as long as it is current at the time of the credentials committee review.
D) Must be verified directly from the DEA within 120 days.
E) Verification is only required at recredentialing.
Correct Answer: C) There is no timeframe, as long as it is current at the time of the
credentials committee review.
Rationale: Unlike some other credentials that have a specific verification "look-back"
period, NCQA requires that the DEA or CDS certificate be verified as current and valid at
the time the credentialing decision is made.
Question 5
According to URAC standards, primary source verification (PSV) or secondary PSV of a
credential may not be collected more than how many months prior to the Credentialing
Committee review?
A) 3 months
B) 6 months
C) 9 months
D) 12 months
E) 24 months
,[Type here]
Correct Answer: B) 6 months
Rationale: URAC specifies that credentialing information must be timely. It sets a limit that
verifications cannot be older than six months at the time the credentialing committee
makes its decision.
Question 6
Does NCQA require a hospital to credential a locum tenens physician who is working in an
independent relationship within the inpatient setting?
A) Yes, if they work for more than 30 days.
B) Yes, all physicians must be credentialed.
C) No, NCQA standards do not require locum tenens to be credentialed in this setting.
D) No, only The Joint Commission requires this.
E) Yes, but only if they are not board certified.
Correct Answer: C) No, NCQA standards do not require locum tenens to be credentialed in
this setting.
Rationale: NCQA's credentialing standards do not apply to practitioners who practice
exclusively within an inpatient setting. Therefore, a locum tenens physician working only in
the hospital would not fall under the NCQA requirement for the health plan to credential
them.
Question 7
The professional practice questions on an application, as required by NCQA, must ask about
which of the following?
A) The applicant's financial history.
B) The correctness and completeness of the application and lack of present illegal drug use.
C) Voluntary relinquishment of privileges for non-quality reasons.
D) Any malpractice claims that did not result in a settlement.
E) The applicant's age and marital status.
Correct Answer: B) The correctness and completeness of the application and lack of present
illegal drug use.
Rationale: NCQA requires a signed attestation that addresses several key areas, including
, [Type here]
the lack of present illegal drug use and a statement that the application is correct and
complete.
Question 8
When evaluating a practitioner for privileges, The Joint Commission (JC) requires the
application to ask about which of the following?
A) The applicant's history of felony convictions.
B) The applicant's current malpractice insurance coverage.
C) Voluntary and involuntary limitation, reduction, or loss of clinical privileges.
D) The applicant's ability to perform the essential functions of the position.
E) Any history of illegal drug use.
Correct Answer: C) Voluntary and involuntary limitation, reduction, or loss of clinical
privileges.
Rationale: The Joint Commission places a strong emphasis on current competence and past
performance. It specifically requires organizations to inquire about any previous loss or
limitation of privileges at other facilities, as this is a key indicator of potential quality or
conduct issues.
Question 9
According to NCQA, when an organization delegates credentialing activities to another entity,
the written delegation document must:
A) Be renewed on a monthly basis.
B) Describe the delegated activities and the responsibilities of both parties.
C) Be approved by the state medical board.
D) Be signed by every practitioner being credentialed.
E) Be made available to the public upon request.
Correct Answer: B) Describe the delegated activities and the responsibilities of both parties.
Rationale: NCQA allows for delegation but requires strict oversight. The foundation of this
oversight is a formal, mutually agreed-upon document that clearly outlines the scope of the
delegated activities, the reporting requirements, and the responsibilities of both the
organization and the delegated entity.
