CPCS COMPLETE VERIFIED STUDY GUIDE EXAM LATEST
2026/2027 UPDATED VERIFIED QUESTIONS AND SOLUTIONS
A+ PASS GUARANTEED |COMPLETE STUDY GUIDE WITH
100% ACCURATE QUESTIONS &ANSWERS. EXCELLENCE
GUARANTEED.
What bodies do not specifically address complaints? Answer: TJC, ACHC, AAAHC
How often does NCQA require the evaluation of complaints? Answer: All practitioners at least
every 6 months
What defines the mechanisms used for complaints according to URAC? Answer: The policies
What is the credentialing committee responsible for in regard to Complaints for URAC?
Answer: Reviews and discusses the performance data and identifies any trends.
According to the DNV, the organization is required to institute a standard grivance procedure
that incudes: Answer: 1. A list of those who should be contacted
2. How the governing body will review and resolve grievances
3. A process for referring quality of care issues to peer review, quality management, or
utilization review.
4. The timeframe during which patient grievances will be reviewed, responded to, and resolved
in a timely manner
5. A provision that the patient will receive a written grievance resolution that includes the
organizational contact, the steps involved in the investigation, the results, and the date the
process was completed.
What would cause CMS Managed Care to require a site visit as soon as possible? Answer:
Complaints about the condition of the site that suggest compromised safety or other concerns
related to the delivery of care
CMS COP: Complaint Answer: Hospital must establish a process for prompt resolution of
patient grievances and must inform each patient whom to contact to file a grievance
1
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,What bodies use the wording, "Require compliance with applicable regulations and law"?
Answer: TJC, URAC, AAHC
CMS Managed Care + "State laws or regulations relating to inclusion or treatment of providers
are superseded by federal law, with the exception of state licensing laws and state laws regarding
plan solvency."
What bodies use the wording, " Require compliance with federal and state laws"? Answer:
NCQA
DNV + organizational policies and procedures
What bodies use the wording, " Require compliance with Medicare CoP, state laws, and local
laws"? Answer: ACHC
What bodies use the wording, "comply with federal law, state law, and the requirements of the
CoP's" Answer: CMS CoP
What bodies address Continuing Education? Answer: TJC, ACHC, DNV
What bodies do not specifically address Continuing Education? Answer: CMS COP, CMS
Managed Care, NCQA, URAC, AAAHC
What documentation of Continuing Education does the Joint Commision allow? Answer: 1.
Copies of program certificates
2. Copy of information submitted for license renewal
3. Obtaining an attestation from the LIP with the stipulation that proof of attendance and
program content will be submitted upon request
TJC: Continuing Education Answer: 1. LIP and other practitioners privileged through the
medical staff process
2. Participation must be documented and considered in decisions for reappointment, renewal, or
revision of clinical privileges.
ACHC may request Continuing Education evidence at what time? Answer: Reappointment
2
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, Who does the DNV require to participate in Continuing Education? Answer: All individuals
with delineated clinical privileges ( CE must be related in part to their clinical privileges)
Can the DNV place an application on hold if the practitioner does not have evidence of
Continuing Education? Answer: Yes. Action on an individual's application for appointment or
reappointment, or initial or subsequent clinical privileges, is withheld until the information is
available and verified.
What bodies specifically address Criminal Background Checks? Answer: CMS COP, TJC,
ACHC
What bodies do not specifically address Criminal Background Checks? Answer: DNV, CMC
Managed Care, NCQA, URAC, AAAHC
Who does the Joint Commission require to have a criminal background check? Answer:
Hospital employees who provide care, treatment, and service
What do the standards for Joint Commission say about Criminal Background Checks? Answer:
Obtained and documented for the applicant as required by state law, regulations, or
organizational policy
Does CMS CoP require Criminal Background Checks? Answer: Required if state law requires.
How long of a criminal history does ACHC request to be reported on a medical staff application?
Answer: 7-10 years
Does ACHC require criminal background checks? Answer: As required by federal and state law
and regulations, the organization must carry out a criminal background checks based on the
information provided by the applicant.
What are the minimum credentials CMS COP require to be examined when evaluation current
competence? Answer: 1. Request for clinical privileges
2. Evidence of current licensure
3. Evidence of training and professional education
4. Documented experience
3
APPHIA - Crafted with Care and Precision for Academic Excellence.
2026/2027 UPDATED VERIFIED QUESTIONS AND SOLUTIONS
A+ PASS GUARANTEED |COMPLETE STUDY GUIDE WITH
100% ACCURATE QUESTIONS &ANSWERS. EXCELLENCE
GUARANTEED.
What bodies do not specifically address complaints? Answer: TJC, ACHC, AAAHC
How often does NCQA require the evaluation of complaints? Answer: All practitioners at least
every 6 months
What defines the mechanisms used for complaints according to URAC? Answer: The policies
What is the credentialing committee responsible for in regard to Complaints for URAC?
Answer: Reviews and discusses the performance data and identifies any trends.
According to the DNV, the organization is required to institute a standard grivance procedure
that incudes: Answer: 1. A list of those who should be contacted
2. How the governing body will review and resolve grievances
3. A process for referring quality of care issues to peer review, quality management, or
utilization review.
4. The timeframe during which patient grievances will be reviewed, responded to, and resolved
in a timely manner
5. A provision that the patient will receive a written grievance resolution that includes the
organizational contact, the steps involved in the investigation, the results, and the date the
process was completed.
What would cause CMS Managed Care to require a site visit as soon as possible? Answer:
Complaints about the condition of the site that suggest compromised safety or other concerns
related to the delivery of care
CMS COP: Complaint Answer: Hospital must establish a process for prompt resolution of
patient grievances and must inform each patient whom to contact to file a grievance
1
APPHIA - Crafted with Care and Precision for Academic Excellence.
,What bodies use the wording, "Require compliance with applicable regulations and law"?
Answer: TJC, URAC, AAHC
CMS Managed Care + "State laws or regulations relating to inclusion or treatment of providers
are superseded by federal law, with the exception of state licensing laws and state laws regarding
plan solvency."
What bodies use the wording, " Require compliance with federal and state laws"? Answer:
NCQA
DNV + organizational policies and procedures
What bodies use the wording, " Require compliance with Medicare CoP, state laws, and local
laws"? Answer: ACHC
What bodies use the wording, "comply with federal law, state law, and the requirements of the
CoP's" Answer: CMS CoP
What bodies address Continuing Education? Answer: TJC, ACHC, DNV
What bodies do not specifically address Continuing Education? Answer: CMS COP, CMS
Managed Care, NCQA, URAC, AAAHC
What documentation of Continuing Education does the Joint Commision allow? Answer: 1.
Copies of program certificates
2. Copy of information submitted for license renewal
3. Obtaining an attestation from the LIP with the stipulation that proof of attendance and
program content will be submitted upon request
TJC: Continuing Education Answer: 1. LIP and other practitioners privileged through the
medical staff process
2. Participation must be documented and considered in decisions for reappointment, renewal, or
revision of clinical privileges.
ACHC may request Continuing Education evidence at what time? Answer: Reappointment
2
APPHIA - Crafted with Care and Precision for Academic Excellence.
, Who does the DNV require to participate in Continuing Education? Answer: All individuals
with delineated clinical privileges ( CE must be related in part to their clinical privileges)
Can the DNV place an application on hold if the practitioner does not have evidence of
Continuing Education? Answer: Yes. Action on an individual's application for appointment or
reappointment, or initial or subsequent clinical privileges, is withheld until the information is
available and verified.
What bodies specifically address Criminal Background Checks? Answer: CMS COP, TJC,
ACHC
What bodies do not specifically address Criminal Background Checks? Answer: DNV, CMC
Managed Care, NCQA, URAC, AAAHC
Who does the Joint Commission require to have a criminal background check? Answer:
Hospital employees who provide care, treatment, and service
What do the standards for Joint Commission say about Criminal Background Checks? Answer:
Obtained and documented for the applicant as required by state law, regulations, or
organizational policy
Does CMS CoP require Criminal Background Checks? Answer: Required if state law requires.
How long of a criminal history does ACHC request to be reported on a medical staff application?
Answer: 7-10 years
Does ACHC require criminal background checks? Answer: As required by federal and state law
and regulations, the organization must carry out a criminal background checks based on the
information provided by the applicant.
What are the minimum credentials CMS COP require to be examined when evaluation current
competence? Answer: 1. Request for clinical privileges
2. Evidence of current licensure
3. Evidence of training and professional education
4. Documented experience
3
APPHIA - Crafted with Care and Precision for Academic Excellence.
