CPCS EXAM STUDY GUIDE
Appointment Timeframe - TJC - ANSWER Not to exceed two years
Appointment Timeframe - NCQA - ANSWER Recredential at least every 3
years.
Cycle to the month.
Appointment Timeframe - HFAP - ANSWER At least every 24 months
Appointment Timeframe - DNV - ANSWER Not to exceed 3 years
Appointment Timeframe - URAC - ANSWER At least every 3 years
Cycle to the month
Appointment Timeframe - AAAHC - ANSWER Not to exceed 3 years
Appointment Timeframe - CMS - ANSWER Practitioner - at least every 24
months
Surgery - every two years
Attestation Statement Timeframe - NCQA - ANSWER 365 days from final
approval
305 - CVO
,Attestation Statement Timeframe - URAC - ANSWER 180 days prior to
credentials committee review
Does not require attestation statement - ANSWER TJC, DNV, CoPs
Board Certification Time Limit - NCQA - ANSWER 180 days
120 days CVO
Board Certification Time Limit - URAC - ANSWER 6 months
Board Certification Verification Required at Recredentialing by - ANSWER
NCQA - verification
HFAP - review
AAAHC
What is typically verified for expiration? - ANSWER Board certification
License (loss of license, sanctions) - NCQA
DEA - AAAHC
Board Certification Verification-Required at Initial and Expiration by -
ANSWER URAC
PSV for Board Certification - ANSWER ABMS, AMA, AOA
State licensing agency if confirmation that agency conducts PSV of board status
Confirmation from board
,NCQA Accepted Source: Verification Requirement for source to Perform PSV-
ANSWER Organization verifies source performs PSV
At least annually organization obtains written confirmation that source performs
PSV
QAPI - ANSWER Medicare CoPs require ongoing evaluation of members
through Quality Assessment Performance Improvement (QAPI) process
shall include grievances about medical staff-related issues
Complaints review - NCQA - ANSWER Evaluate complaint history for all
practitioners at least semi-annually
CME not addressed by - ANSWER NCQA, URAC, AAAHC, CoPs
CVO review - TJC - ANSWER 9 elements
Information & Data available
steps or processes involved
limitations of information
differentiation of primary source from secondary source
quality control measures concerning data integrity, security, transmission, etc.
Background Criminal Check - HFAP - ANSWER Application for criminal
history for 7 - 10 years
Facility conducts background investigation as necessary
Background Criminal Check required by - ANSWER TJC, HFAP
, FSMB - ANSWER Federation of State Medical Boards
all adverse actions taken against a physician's medical license
used by TJC, HFAP
Disciplinary actions: state licensing agency, board actions, or if physician is
clean.
Disciplinary alert service: notification for report of MD, DO, or PA
NPDB information available: - ANSWER Medical malpractice payments
Adverse licensure action
Dismissal or closure of proceedings
Adverse clinical privileging actions
Adverse professional society membership
Negative action or finding by State licensing or certification authority
Peer review negative findings
Adverse actions against DEA certification
Medicare Exclusion
Education & Residency/post-grad Verification Sources - ANSWER AMA,
AOA,
ECFMG - foreign medical school
AMA - ANSWER American Medical Association
PSV education, state licensure, current/prior medical training, DEA status,
Sanctions (Medicaid/Medicare), Board by AMBS
Appointment Timeframe - TJC - ANSWER Not to exceed two years
Appointment Timeframe - NCQA - ANSWER Recredential at least every 3
years.
Cycle to the month.
Appointment Timeframe - HFAP - ANSWER At least every 24 months
Appointment Timeframe - DNV - ANSWER Not to exceed 3 years
Appointment Timeframe - URAC - ANSWER At least every 3 years
Cycle to the month
Appointment Timeframe - AAAHC - ANSWER Not to exceed 3 years
Appointment Timeframe - CMS - ANSWER Practitioner - at least every 24
months
Surgery - every two years
Attestation Statement Timeframe - NCQA - ANSWER 365 days from final
approval
305 - CVO
,Attestation Statement Timeframe - URAC - ANSWER 180 days prior to
credentials committee review
Does not require attestation statement - ANSWER TJC, DNV, CoPs
Board Certification Time Limit - NCQA - ANSWER 180 days
120 days CVO
Board Certification Time Limit - URAC - ANSWER 6 months
Board Certification Verification Required at Recredentialing by - ANSWER
NCQA - verification
HFAP - review
AAAHC
What is typically verified for expiration? - ANSWER Board certification
License (loss of license, sanctions) - NCQA
DEA - AAAHC
Board Certification Verification-Required at Initial and Expiration by -
ANSWER URAC
PSV for Board Certification - ANSWER ABMS, AMA, AOA
State licensing agency if confirmation that agency conducts PSV of board status
Confirmation from board
,NCQA Accepted Source: Verification Requirement for source to Perform PSV-
ANSWER Organization verifies source performs PSV
At least annually organization obtains written confirmation that source performs
PSV
QAPI - ANSWER Medicare CoPs require ongoing evaluation of members
through Quality Assessment Performance Improvement (QAPI) process
shall include grievances about medical staff-related issues
Complaints review - NCQA - ANSWER Evaluate complaint history for all
practitioners at least semi-annually
CME not addressed by - ANSWER NCQA, URAC, AAAHC, CoPs
CVO review - TJC - ANSWER 9 elements
Information & Data available
steps or processes involved
limitations of information
differentiation of primary source from secondary source
quality control measures concerning data integrity, security, transmission, etc.
Background Criminal Check - HFAP - ANSWER Application for criminal
history for 7 - 10 years
Facility conducts background investigation as necessary
Background Criminal Check required by - ANSWER TJC, HFAP
, FSMB - ANSWER Federation of State Medical Boards
all adverse actions taken against a physician's medical license
used by TJC, HFAP
Disciplinary actions: state licensing agency, board actions, or if physician is
clean.
Disciplinary alert service: notification for report of MD, DO, or PA
NPDB information available: - ANSWER Medical malpractice payments
Adverse licensure action
Dismissal or closure of proceedings
Adverse clinical privileging actions
Adverse professional society membership
Negative action or finding by State licensing or certification authority
Peer review negative findings
Adverse actions against DEA certification
Medicare Exclusion
Education & Residency/post-grad Verification Sources - ANSWER AMA,
AOA,
ECFMG - foreign medical school
AMA - ANSWER American Medical Association
PSV education, state licensure, current/prior medical training, DEA status,
Sanctions (Medicaid/Medicare), Board by AMBS
