CPCS CERTIFICATION MASTERY BUNDLE
2026 AND 2027 COMPLETE QUESTIONS AND
ANSWERS 100% ACCURATE EDITION.
◎ 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
◎ According to The Joint Commission standards, which of following is considered a
designated equivalent source for verification of board certification? ANSWER:- The
American Board of Medical Specialties
2026 AND 2027 COMPLETE QUESTIONS AND
ANSWERS 100% ACCURATE EDITION.
◎ 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
◎ According to The Joint Commission standards, which of following is considered a
designated equivalent source for verification of board certification? ANSWER:- The
American Board of Medical Specialties
