CPCS Exam 318 Questions and Answers
(2026) with Complete Solutions
According to the JC a fair hearing and appeals process as described in the medical staff
bylaws is available to whom? - ANSWER-Medical staff members and non-members
holding clinical privileges
T/F Only the highest of training must be verified according to NCQA - ANSWER-True
According to the Joint Commission a peer recommendation should address what six
competencies? - ANSWER-Medical knowledge\nTechnical & clinical skill\nclinical
judgment\ninterpersonal skills\ncommunication skills\nprofessionalism
Telemedicine - according to JC what two options are available for credentialing a the
original site? - ANSWER-Full credentialing, use of the distant sites credentialing
According to JC what is included in the process of planning and implementing
privileges? - ANSWER-Develop & approve procedure list\nProcess the
application\nEvaluate applicant specific information\nSubmit recommendations to
governing body for applicant specific delineated privileges\nNotify the applicant,
relevant personnel\nMonitor the use of privileges
Are payments made by a physician in a malpractice claim reportable to the NPDB? -
ANSWER-No
Who requires Peer References - ANSWER-JC, HFAP, AAAHC
Who reappoints - ANSWER-JC, HFAP, NCQA, URAC
What two accreditors state: a hospital may not rely solely on board certification when
considering practitioner for medical staff membership? - ANSWER-HFAP, CMS
According to JC & HFAP name four approved sources PSV for Medical Education -
ANSWER-Medical School, AMA, ECFMG, AOA
According to NCQA practitioners must be notified of credentialing decision within how
many days? - ANSWER-60 Days
The DHHS mails a copy of the NPDB report to the named provider. If the provider
wishes to dispute the reports accuracy, the provider has how many days to do so? -
ANSWER-60 Days
According to URAQ, within how many days must the practitioner be notified of
credentialing decisions? - ANSWER-10 Days
,How many days does a practitioner have to dispute an NPDB report accuracy -
ANSWER-60 Days
Which accrediting body requires five year verification of malpractice history - ANSWER-
NCQA
What is commonly used source for verifying malpractice history - ANSWER-NPDB
Who requires an attestation? - ANSWER-NCQA, URAC, AAAHC
Who requires education verification? - ANSWER-JC, HFAP, URAC, AAAHC
Who requires statement regarding felony convictions? - ANSWER-HFAP, NCQA,
AAAHC
Attestation must state that the information submitted is complete & correct - ANSWER-
NCQA, AAAHC
Attestation must state that the information submitted is complete & accurate -
ANSWER-URAC
Attestation must include inquiry regarding illegal drug use? - ANSWER-NCAQ
Attestation must include inquiry regarding inability to perform essential functions? -
ANSWER-NCQA
Attestation must include inquiry regarding history or loss or limitations of licensure or
privileges or disciplinary actions? - ANSWER-NCQA
Attestation must include inquiry regarding current malpractice coverage? - ANSWER-
NCQA
Attestation must include inquiry regarding felony convictions? - ANSWER-NCQA
Applicant must attest to limitations on ability to perform functions of the position with or
without accomodation, if any - ANSWER-NCQA
Applicant must attest to lack of present illegal drug use - ANSWER-AAAHC
Applicant must attest to history or loss of license and felony convictions, if any -
ANSWER-AAAHC
Applicant must attest to history of loss or limitations of privileges or disciplinary actions,
if any - ANSWER-AAAHC
, Applicant must attest to current malpractice insurance coverage? - ANSWER-AAAHC
Who requires a malpractice history for applicants? - ANSWER-JC, HFAP, NCQA,
URAC, AAAHC
Who must have a process in place to address complaints? - ANSWER-JC, HFAP,
NCQA, URAC
Who requires Board Certification? - ANSWER-None
Who requires criminal background checks? - ANSWER-HFAP
Who requires applicant ID - ANSWER-JC
Who requires an NPDB - ANSWER-JC, HFAP, NCQA, AAAHC
Who requires current competence? - ANSWER-JC, HFAP, CMS
How often does the OIG report to the NPDB? - ANSWER-Monthly
Are limitations of the clinical privileges of a psychiatrist for more than 30 days reportable
to the NPDB? - ANSWER-Yes
According to the JC, who may amend the medical staff bylaws? - ANSWER-Governing
Body
Failure to meet the established qualifications and criteria for appointment should be
reported to whom? - ANSWER-The applicant
NCQA requires the MCO to obtain a minimum of ???? years of work history? -
ANSWER-Five Years
According to NCQA what policy must an organization have in place to obtain approval
to enter into a delegated agreement? - ANSWER-Credentialing policies
Hospitals must query the NPDB when: - ANSWER-Initial appointment\ngranting of
priveleges\nevery two years
NCQA requires verifications must be less than how many days old? - ANSWER-180
What is the verification time limit on malpractice history according to the NCQA? -
ANSWER-180 days
Time limited credential must be verified by the CVO within how many days prior to
submission to the client? - ANSWER-120 days
(2026) with Complete Solutions
According to the JC a fair hearing and appeals process as described in the medical staff
bylaws is available to whom? - ANSWER-Medical staff members and non-members
holding clinical privileges
T/F Only the highest of training must be verified according to NCQA - ANSWER-True
According to the Joint Commission a peer recommendation should address what six
competencies? - ANSWER-Medical knowledge\nTechnical & clinical skill\nclinical
judgment\ninterpersonal skills\ncommunication skills\nprofessionalism
Telemedicine - according to JC what two options are available for credentialing a the
original site? - ANSWER-Full credentialing, use of the distant sites credentialing
According to JC what is included in the process of planning and implementing
privileges? - ANSWER-Develop & approve procedure list\nProcess the
application\nEvaluate applicant specific information\nSubmit recommendations to
governing body for applicant specific delineated privileges\nNotify the applicant,
relevant personnel\nMonitor the use of privileges
Are payments made by a physician in a malpractice claim reportable to the NPDB? -
ANSWER-No
Who requires Peer References - ANSWER-JC, HFAP, AAAHC
Who reappoints - ANSWER-JC, HFAP, NCQA, URAC
What two accreditors state: a hospital may not rely solely on board certification when
considering practitioner for medical staff membership? - ANSWER-HFAP, CMS
According to JC & HFAP name four approved sources PSV for Medical Education -
ANSWER-Medical School, AMA, ECFMG, AOA
According to NCQA practitioners must be notified of credentialing decision within how
many days? - ANSWER-60 Days
The DHHS mails a copy of the NPDB report to the named provider. If the provider
wishes to dispute the reports accuracy, the provider has how many days to do so? -
ANSWER-60 Days
According to URAQ, within how many days must the practitioner be notified of
credentialing decisions? - ANSWER-10 Days
,How many days does a practitioner have to dispute an NPDB report accuracy -
ANSWER-60 Days
Which accrediting body requires five year verification of malpractice history - ANSWER-
NCQA
What is commonly used source for verifying malpractice history - ANSWER-NPDB
Who requires an attestation? - ANSWER-NCQA, URAC, AAAHC
Who requires education verification? - ANSWER-JC, HFAP, URAC, AAAHC
Who requires statement regarding felony convictions? - ANSWER-HFAP, NCQA,
AAAHC
Attestation must state that the information submitted is complete & correct - ANSWER-
NCQA, AAAHC
Attestation must state that the information submitted is complete & accurate -
ANSWER-URAC
Attestation must include inquiry regarding illegal drug use? - ANSWER-NCAQ
Attestation must include inquiry regarding inability to perform essential functions? -
ANSWER-NCQA
Attestation must include inquiry regarding history or loss or limitations of licensure or
privileges or disciplinary actions? - ANSWER-NCQA
Attestation must include inquiry regarding current malpractice coverage? - ANSWER-
NCQA
Attestation must include inquiry regarding felony convictions? - ANSWER-NCQA
Applicant must attest to limitations on ability to perform functions of the position with or
without accomodation, if any - ANSWER-NCQA
Applicant must attest to lack of present illegal drug use - ANSWER-AAAHC
Applicant must attest to history or loss of license and felony convictions, if any -
ANSWER-AAAHC
Applicant must attest to history of loss or limitations of privileges or disciplinary actions,
if any - ANSWER-AAAHC
, Applicant must attest to current malpractice insurance coverage? - ANSWER-AAAHC
Who requires a malpractice history for applicants? - ANSWER-JC, HFAP, NCQA,
URAC, AAAHC
Who must have a process in place to address complaints? - ANSWER-JC, HFAP,
NCQA, URAC
Who requires Board Certification? - ANSWER-None
Who requires criminal background checks? - ANSWER-HFAP
Who requires applicant ID - ANSWER-JC
Who requires an NPDB - ANSWER-JC, HFAP, NCQA, AAAHC
Who requires current competence? - ANSWER-JC, HFAP, CMS
How often does the OIG report to the NPDB? - ANSWER-Monthly
Are limitations of the clinical privileges of a psychiatrist for more than 30 days reportable
to the NPDB? - ANSWER-Yes
According to the JC, who may amend the medical staff bylaws? - ANSWER-Governing
Body
Failure to meet the established qualifications and criteria for appointment should be
reported to whom? - ANSWER-The applicant
NCQA requires the MCO to obtain a minimum of ???? years of work history? -
ANSWER-Five Years
According to NCQA what policy must an organization have in place to obtain approval
to enter into a delegated agreement? - ANSWER-Credentialing policies
Hospitals must query the NPDB when: - ANSWER-Initial appointment\ngranting of
priveleges\nevery two years
NCQA requires verifications must be less than how many days old? - ANSWER-180
What is the verification time limit on malpractice history according to the NCQA? -
ANSWER-180 days
Time limited credential must be verified by the CVO within how many days prior to
submission to the client? - ANSWER-120 days
