CPCS EXAM SCRIPT UPDATED QUESTIONS AND
ANSWERS SURE A+
✔✔Applicant must attest to limitations on ability to perform functions of the position with
or without accomodation, if any - ✔✔NCQA
✔✔Applicant must attest to lack of present illegal drug use - ✔✔AAAHC
✔✔Applicant must attest to history or loss of license and felony convictions, if any -
✔✔AAAHC
✔✔Applicant must attest to history of loss or limitations of privileges or disciplinary
actions, if any - ✔✔AAAHC
✔✔Applicant must attest to current malpractice insurance coverage? - ✔✔AAAHC
✔✔Who requires a malpractice history for applicants? - ✔✔JC, HFAP, NCQA, URAC,
AAAHC
✔✔Who must have a process in place to address complaints? - ✔✔JC, HFAP, NCQA,
URAC
✔✔Who requires Board Certification? - ✔✔None
✔✔Who requires criminal background checks? - ✔✔HFAP
✔✔Who requires applicant ID - ✔✔JC
✔✔Who requires an NPDB - ✔✔JC, HFAP, NCQA, AAAHC
✔✔Who requires current competence? - ✔✔JC, HFAP, CMS
✔✔How often does the OIG report to the NPDB? - ✔✔Monthly
✔✔Are limitations of the clinical privileges of a psychiatrist for more than 30 days
reportable to the NPDB? - ✔✔Yes
✔✔According to the JC, who may amend the medical staff bylaws? - ✔✔Governing
Body
✔✔Failure to meet the established qualifications and criteria for appointment should be
reported to whom? - ✔✔The applicant
,✔✔NCQA requires the MCO to obtain a minimum of ???? years of work history? -
✔✔Five Years
✔✔According to NCQA what policy must an organization have in place to obtain
approval to enter into a delegated agreement? - ✔✔Credentialing policies
✔✔Hospitals must query the NPDB when: - ✔✔Initial appointment\ngranting of
priveleges\nevery two years
✔✔NCQA requires verifications must be less than how many days old? - ✔✔180
✔✔What is the verification time limit on malpractice history according to the NCQA? -
✔✔180 days
✔✔Time limited credential must be verified by the CVO within how many days prior to
submission to the client? - ✔✔120 days
✔✔According to AAAHC, for initial appointments, in addition to licensure and education,
what verification is required? - ✔✔Experience and hospital affiliation
✔✔What accreditation body states "the NPDB is an acceptable source for sanctions or
limitations on licensure, Medicaid/Medicare sanctions and malpractice history? -
✔✔NCQA
✔✔Who is required to query the NPDB - ✔✔Hospitals
✔✔Is disciplinary action taken against the license of a dentist reportable to the NPDB? -
✔✔Yes
✔✔Under HCQIA, a hospital failure to report an adverse privilege action lasting longer
than 30 days may cause the organization to lose HCQIA immunity for how many years?
- ✔✔3 years
✔✔According to NCQA verification of Medicare/Medicaid sanctions can be queried by
any of what sources? - ✔✔AMA, FSMB, HIPDB, OIG, Sanctions Report, NPDB, State
Agency
✔✔According to NCQA, how often must an organization conduct an audit of the
credentialing process delegated to another organization? - ✔✔Annually
✔✔How far back does the Joint Commission require evaluation of malpractice history? -
✔✔Back to Medical School
, ✔✔According to JC, what source may be used to verify malpractice history? - ✔✔NPDB
✔✔Is an internet verification from a website not contracted by the primary source that
attest to the accuracy and timeliness of the information considered a complete
verification by NCQA? - ✔✔No
✔✔What accreditation bodies require privileges to be distributed to essential
department personnnel? - ✔✔Joint Commission - CMS
✔✔Who requires background checks? - ✔✔HFAP (the only organization that requires)
✔✔Is a payment made by an insurance company reportable to the NPDB? - ✔✔Yes
✔✔According to NCQA what providers are NOT required to be credentialed when
working in an independent relationship? - ✔✔Locum Tenens\nHospital based
practitioners (i.e., anesthesia, pathology, radiology, etc.)
✔✔Is denial of a medical license application by a state medical board reportable to the
NPDB - ✔✔Yes
✔✔Telemedicine - according to JC what two options are available for credentialing at
the originating site? - ✔✔Full credentialing\nUse of the distant sites credentialing
✔✔What two accreditors state: a hospital may not rely solely on board certification
when considering practitioner for medical staff membership - ✔✔HFAP, CMS
✔✔According to who? Medical School, AMA, ECFMG, AOA are approves sources of
medical education? - ✔✔JC, HFAP
✔✔According to NCQA practitioners must be notified of credentialing decision within
how many days? - ✔✔60 Days
✔✔How long does a named provider have to dispute the accuracy of an NPDB report? -
✔✔60 Days
✔✔According to URAC, within how many days must the practitioner be notified of
credentialing decisions? - ✔✔10 Days
✔✔How many days does a practitioner have to dispute an NPDB report accuracy? -
✔✔60 Days
ANSWERS SURE A+
✔✔Applicant must attest to limitations on ability to perform functions of the position with
or without accomodation, if any - ✔✔NCQA
✔✔Applicant must attest to lack of present illegal drug use - ✔✔AAAHC
✔✔Applicant must attest to history or loss of license and felony convictions, if any -
✔✔AAAHC
✔✔Applicant must attest to history of loss or limitations of privileges or disciplinary
actions, if any - ✔✔AAAHC
✔✔Applicant must attest to current malpractice insurance coverage? - ✔✔AAAHC
✔✔Who requires a malpractice history for applicants? - ✔✔JC, HFAP, NCQA, URAC,
AAAHC
✔✔Who must have a process in place to address complaints? - ✔✔JC, HFAP, NCQA,
URAC
✔✔Who requires Board Certification? - ✔✔None
✔✔Who requires criminal background checks? - ✔✔HFAP
✔✔Who requires applicant ID - ✔✔JC
✔✔Who requires an NPDB - ✔✔JC, HFAP, NCQA, AAAHC
✔✔Who requires current competence? - ✔✔JC, HFAP, CMS
✔✔How often does the OIG report to the NPDB? - ✔✔Monthly
✔✔Are limitations of the clinical privileges of a psychiatrist for more than 30 days
reportable to the NPDB? - ✔✔Yes
✔✔According to the JC, who may amend the medical staff bylaws? - ✔✔Governing
Body
✔✔Failure to meet the established qualifications and criteria for appointment should be
reported to whom? - ✔✔The applicant
,✔✔NCQA requires the MCO to obtain a minimum of ???? years of work history? -
✔✔Five Years
✔✔According to NCQA what policy must an organization have in place to obtain
approval to enter into a delegated agreement? - ✔✔Credentialing policies
✔✔Hospitals must query the NPDB when: - ✔✔Initial appointment\ngranting of
priveleges\nevery two years
✔✔NCQA requires verifications must be less than how many days old? - ✔✔180
✔✔What is the verification time limit on malpractice history according to the NCQA? -
✔✔180 days
✔✔Time limited credential must be verified by the CVO within how many days prior to
submission to the client? - ✔✔120 days
✔✔According to AAAHC, for initial appointments, in addition to licensure and education,
what verification is required? - ✔✔Experience and hospital affiliation
✔✔What accreditation body states "the NPDB is an acceptable source for sanctions or
limitations on licensure, Medicaid/Medicare sanctions and malpractice history? -
✔✔NCQA
✔✔Who is required to query the NPDB - ✔✔Hospitals
✔✔Is disciplinary action taken against the license of a dentist reportable to the NPDB? -
✔✔Yes
✔✔Under HCQIA, a hospital failure to report an adverse privilege action lasting longer
than 30 days may cause the organization to lose HCQIA immunity for how many years?
- ✔✔3 years
✔✔According to NCQA verification of Medicare/Medicaid sanctions can be queried by
any of what sources? - ✔✔AMA, FSMB, HIPDB, OIG, Sanctions Report, NPDB, State
Agency
✔✔According to NCQA, how often must an organization conduct an audit of the
credentialing process delegated to another organization? - ✔✔Annually
✔✔How far back does the Joint Commission require evaluation of malpractice history? -
✔✔Back to Medical School
, ✔✔According to JC, what source may be used to verify malpractice history? - ✔✔NPDB
✔✔Is an internet verification from a website not contracted by the primary source that
attest to the accuracy and timeliness of the information considered a complete
verification by NCQA? - ✔✔No
✔✔What accreditation bodies require privileges to be distributed to essential
department personnnel? - ✔✔Joint Commission - CMS
✔✔Who requires background checks? - ✔✔HFAP (the only organization that requires)
✔✔Is a payment made by an insurance company reportable to the NPDB? - ✔✔Yes
✔✔According to NCQA what providers are NOT required to be credentialed when
working in an independent relationship? - ✔✔Locum Tenens\nHospital based
practitioners (i.e., anesthesia, pathology, radiology, etc.)
✔✔Is denial of a medical license application by a state medical board reportable to the
NPDB - ✔✔Yes
✔✔Telemedicine - according to JC what two options are available for credentialing at
the originating site? - ✔✔Full credentialing\nUse of the distant sites credentialing
✔✔What two accreditors state: a hospital may not rely solely on board certification
when considering practitioner for medical staff membership - ✔✔HFAP, CMS
✔✔According to who? Medical School, AMA, ECFMG, AOA are approves sources of
medical education? - ✔✔JC, HFAP
✔✔According to NCQA practitioners must be notified of credentialing decision within
how many days? - ✔✔60 Days
✔✔How long does a named provider have to dispute the accuracy of an NPDB report? -
✔✔60 Days
✔✔According to URAC, within how many days must the practitioner be notified of
credentialing decisions? - ✔✔10 Days
✔✔How many days does a practitioner have to dispute an NPDB report accuracy? -
✔✔60 Days
