1|Page
CPCS NAMSS EXAM AND STUDY GUIDE NEWEST 2025
TEST BANK| NAMSS CERTIFIED PROVIDER
CREDENTIALING SPECIALIST FINAL EXAM PREP
WITH 400 REAL EXAM QUESTIONS AND CORRECT
VERIFIED ANSWERS/ GRADED A+ (BRAND NEW!!)
What is the name of the act, known as the Federal "anti-dumping" law,
which was enacted to stop hospitals transferring, discharging, or refusing
to treat indigent patients coming to the emergency department because
of cost factors?
a. EMTALA
b. Transfer of indigent patients act
c. Sherman act - Correct Answer - a. EMTALA
In the case of Frigo vs. Silver Cross Hospital, the podiatrist who
performed surgery on Ms. Frigo did not meet initial criteria or revised
criteria for Level II surgical privileges, but was granted privileges
regardless. What was the legal concept under which the jury found
Silver Cross Hospital to be negligent?
a. Breach of duty/Corporate negligence
b. Respondent superior
c. Antitrust - Correct Answer - a. Breach of duty/Corporate negligence
pg. 1
,2|Page
Which continuing medical education system has become the CME
standard for licensing boards and specialty organizations nationwide and
is recognized by U.S. jurisdictions?
a. The AMA's PRA category 1 credit system
b. The ACGME's CME program
c. FSMB's profile report - Correct Answer - a. The AMA's PRA category
1 credit system
According to TJC standards, the qualifications and competence of a non-
employee individual, other than a PA or APRN, who is brought into the
hospital by an LP to provide care, treatment, must be assessed by
a. the hospital
b. the department chairperson
c. the medical staff executive committee - Correct Answer - a. the
hospital
According to TJC standards, who must inform the patient about
unanticipated outcomes of care, treatment, and services related to
sentinel events?
a. Medical staff executive committee
b. Risk manager
c. Responsible licensed independent practitioner or his or her designee -
Correct Answer - c. Responsible licensed independent practitioner or his
or her designee
pg. 2
,3|Page
You are working at a AAAHC-accredited facility and are credentialing a
new applicant. In addition to verifying licensure, DEA, education,
training and malpractice insurance, what other credentials are required to
be primary or secondary source verified according to AAAHC
standards?
a. malpractice history and peer references
b. peer references and NPDB
c. board certification, malpractice history, and peer references - Correct
Answer - b. peer references and NPDB
Which term is used to describe the use of criteria unrelated to quality of
care or professional competency in determining an individual's
qualifications for initial or continuing hospital medical staff appointment
or privileges or continued participation in a provider panel of a managed
care plan?
a. credentialing criteria
b. case management
c. economic credentialing - Correct Answer - c. economic credentialing
Which term describes skilled and intermediate nursing facilities, hospice
programs, community mental health centers, and home health care
systems are designed to provide needed services in manner that is more
cost effective than in a hospital?
a. alternative delivery systems
b. skilled care systems
pg. 3
, 4|Page
c. managed care - Correct Answer - a. alternative delivery systems
Which term describes an organization which reviews services provided
under the Medicare program to determine whether a hospital has
misrepresented admission or discharge information or has taken an
action that results in the unnecessary admission of an individual entitled
to benefits under Medicare Part A?
a. national committee on quality assurance
b. Joint commission on accreditation of healthcare organizations
c. peer review organization - Correct Answer - c. peer review
organization
In selecting a new information system, the primary consideration should
be the
a. cost of the system
b. requirements of the user
c. available technology - Correct Answer - c. available technology
According to the DNV, if the medical staff has an executive committee,
who must attend the meetings?
a. medical staff members and CEO
b. medical staff members only
c. medical staff members, CEO and CNO (or designee) on an ex-officio
basis - Correct Answer - c.
pg. 4
CPCS NAMSS EXAM AND STUDY GUIDE NEWEST 2025
TEST BANK| NAMSS CERTIFIED PROVIDER
CREDENTIALING SPECIALIST FINAL EXAM PREP
WITH 400 REAL EXAM QUESTIONS AND CORRECT
VERIFIED ANSWERS/ GRADED A+ (BRAND NEW!!)
What is the name of the act, known as the Federal "anti-dumping" law,
which was enacted to stop hospitals transferring, discharging, or refusing
to treat indigent patients coming to the emergency department because
of cost factors?
a. EMTALA
b. Transfer of indigent patients act
c. Sherman act - Correct Answer - a. EMTALA
In the case of Frigo vs. Silver Cross Hospital, the podiatrist who
performed surgery on Ms. Frigo did not meet initial criteria or revised
criteria for Level II surgical privileges, but was granted privileges
regardless. What was the legal concept under which the jury found
Silver Cross Hospital to be negligent?
a. Breach of duty/Corporate negligence
b. Respondent superior
c. Antitrust - Correct Answer - a. Breach of duty/Corporate negligence
pg. 1
,2|Page
Which continuing medical education system has become the CME
standard for licensing boards and specialty organizations nationwide and
is recognized by U.S. jurisdictions?
a. The AMA's PRA category 1 credit system
b. The ACGME's CME program
c. FSMB's profile report - Correct Answer - a. The AMA's PRA category
1 credit system
According to TJC standards, the qualifications and competence of a non-
employee individual, other than a PA or APRN, who is brought into the
hospital by an LP to provide care, treatment, must be assessed by
a. the hospital
b. the department chairperson
c. the medical staff executive committee - Correct Answer - a. the
hospital
According to TJC standards, who must inform the patient about
unanticipated outcomes of care, treatment, and services related to
sentinel events?
a. Medical staff executive committee
b. Risk manager
c. Responsible licensed independent practitioner or his or her designee -
Correct Answer - c. Responsible licensed independent practitioner or his
or her designee
pg. 2
,3|Page
You are working at a AAAHC-accredited facility and are credentialing a
new applicant. In addition to verifying licensure, DEA, education,
training and malpractice insurance, what other credentials are required to
be primary or secondary source verified according to AAAHC
standards?
a. malpractice history and peer references
b. peer references and NPDB
c. board certification, malpractice history, and peer references - Correct
Answer - b. peer references and NPDB
Which term is used to describe the use of criteria unrelated to quality of
care or professional competency in determining an individual's
qualifications for initial or continuing hospital medical staff appointment
or privileges or continued participation in a provider panel of a managed
care plan?
a. credentialing criteria
b. case management
c. economic credentialing - Correct Answer - c. economic credentialing
Which term describes skilled and intermediate nursing facilities, hospice
programs, community mental health centers, and home health care
systems are designed to provide needed services in manner that is more
cost effective than in a hospital?
a. alternative delivery systems
b. skilled care systems
pg. 3
, 4|Page
c. managed care - Correct Answer - a. alternative delivery systems
Which term describes an organization which reviews services provided
under the Medicare program to determine whether a hospital has
misrepresented admission or discharge information or has taken an
action that results in the unnecessary admission of an individual entitled
to benefits under Medicare Part A?
a. national committee on quality assurance
b. Joint commission on accreditation of healthcare organizations
c. peer review organization - Correct Answer - c. peer review
organization
In selecting a new information system, the primary consideration should
be the
a. cost of the system
b. requirements of the user
c. available technology - Correct Answer - c. available technology
According to the DNV, if the medical staff has an executive committee,
who must attend the meetings?
a. medical staff members and CEO
b. medical staff members only
c. medical staff members, CEO and CNO (or designee) on an ex-officio
basis - Correct Answer - c.
pg. 4
