CPCS FINAL EXAM ACTUAL QUESTIONS AND ANSWERS
SURE A+
✔✔According to NCQA standards, if deficiences are noted during a site visit an action
plan must be developed. The office site must implement the plan within ?????? of the
initial visit? - ✔✔6 Months
✔✔If the physician is notified of an adverse recommendation and requests a hearing
what is required in the notice? - ✔✔1. Place, time and date\n2. Hearing date within 30
days from date of notice\n3. List of witnesses
✔✔What is the time limit on PSV of current licensure according to NCQA - ✔✔180 Days
✔✔When an applicant for membership or privileges with a clean application is awaiting
approval of MEC and the governing body, temporary privileges may be granted for a
limited time not to exceed? - ✔✔120 Days
✔✔What is the NCQA timeframe for appointment? - ✔✔every 36 months to the month
✔✔What is the HFAP appointment timeframe? - ✔✔not to exceed 2 years
✔✔What is JC appointment timeframe? - ✔✔not to exceed 2 years
✔✔What is the URAC appointment timeframe? - ✔✔every 3 years to the month & day
✔✔As defined by state law who had the appointment timeframe not to exceed 3 years?
- ✔✔URAC
✔✔Who recommends appraisal at least every 24 months if state law does not establsh?
- ✔✔CMS
✔✔Who requires an attestation statement? - ✔✔URAC, HFAP, NCQA
✔✔Who must conduct site visits for complaints & evaluate every 6 months? - ✔✔NCQA
✔✔Who requires CME? - ✔✔JC
✔✔Who requires current competence? - ✔✔TJC, HFAP, AAAHC
✔✔Who says the Governing Board must ensure competence? - ✔✔JC
✔✔Who says if state law requires background checks then they are required? -
✔✔CMS
,✔✔Who allows state licensing board to verify education if the state board verifies the
credentials? - ✔✔URAC
✔✔Who request felony convictions? - ✔✔NCQA, HFAP, AAAHC
✔✔Professional reference must include health status? - ✔✔HFAP
✔✔Does CMS address sanctions? - ✔✔No
✔✔Who allows FSMB to verify license sanctions? - ✔✔JC, NCQA, HFAP
✔✔Malpractice coverage is necessary for what accreditation systems? - ✔✔NCQA,
HFAP, URAC
✔✔Who uses five year history for evaluation of malpractice? - ✔✔NCQA, HFAP
✔✔What is the accepted time limit of malpractice history for URAC? - ✔✔6 Months
✔✔What is the verification time limit for medicare sanctions for NCQA? - ✔✔180 days
✔✔Who has provisional credentialing? - ✔✔NCQA, URAC
✔✔Who has temporary privileges? - ✔✔JC, HFAP
✔✔Who requires peer recommendations? - ✔✔JC, HFAP, AAAHC
✔✔Does NCQA use credentialing committee to make recommendations? - ✔✔Yes
✔✔Can HFAP use credentialing committee to make recommendations? - ✔✔Yes
✔✔Does JC require work history verification? - ✔✔No
✔✔Who on initial appointment review work history for continuity and relevance? -
✔✔AAAHC
✔✔Who requires that all licensed independent practitoners must be credentialed and
privileged through the organized Medical Staff structure? - ✔✔JC
✔✔NCQA current licensure verification time limit of CVO? - ✔✔120 days
✔✔NCQA malpractice verification time limits for CVO? - ✔✔120 days
, ✔✔NCQA time limits on professional liability / malpractice for CVO? - ✔✔Must be
current, valid and verified within 305 calendar days prior to submission to each client
✔✔What is the main reason for periodically assessing appropriateness of clinical
privileges for each specialty? - ✔✔To protect patient safety by ensuring current
competency, revelance to the facility and accepted standards of trade.
✔✔Telemedicine originating site is? - ✔✔Site where the patient is receiving care is
located
✔✔This legislation prohibits a physician with a financial arrangement with an entity from
referring Medicare or Medicaid patients to that entity. - ✔✔Stark Law
✔✔Verification time limit for licensure per NCQA CVO standards? - ✔✔120 days
✔✔Per NCQA standards on initial applications, review of information on sanctions,
restrictions, on licensure and limitations on scope of practice must cover what period of
time? - ✔✔The most recent 5-years
✔✔In the MCO, a review board or Governing Body may review a credentialing decision
after the Credentialing Committee approval. What date does the NCQA use when
assessing performance against timeliness requirements for PSV? - ✔✔Decision date of
the Credentials Committee
✔✔JC approved designated sources for verification against a physician's medical
license? - ✔✔FSMB, State Medical Boards
✔✔This federal law was enacted for the purpose of encouraging good faith professional
review activities: - ✔✔Health Care Quality Improvement Act of 1986 (HCQIA)
✔✔At reappointment NCQA requires 4 factors within prescribed time limits: - ✔✔1. DEA
or CVS\n2. Board Certification\n3. Liability Claims, settled or judgments\n4. Licensure
✔✔What are the CMS criteria for selection to the medical staff? -
✔✔CompetencyCharacter\nJudgment\nExperience Training
✔✔NCQA requires these factors prior to provisional credentialing? - ✔✔Current
license\nPast 5 years of claims, settlements or NPDB report\nApplication with signed
attestation
✔✔AAAHC requires recredentialing every 3 years except for: - ✔✔When state
regulations require less time
SURE A+
✔✔According to NCQA standards, if deficiences are noted during a site visit an action
plan must be developed. The office site must implement the plan within ?????? of the
initial visit? - ✔✔6 Months
✔✔If the physician is notified of an adverse recommendation and requests a hearing
what is required in the notice? - ✔✔1. Place, time and date\n2. Hearing date within 30
days from date of notice\n3. List of witnesses
✔✔What is the time limit on PSV of current licensure according to NCQA - ✔✔180 Days
✔✔When an applicant for membership or privileges with a clean application is awaiting
approval of MEC and the governing body, temporary privileges may be granted for a
limited time not to exceed? - ✔✔120 Days
✔✔What is the NCQA timeframe for appointment? - ✔✔every 36 months to the month
✔✔What is the HFAP appointment timeframe? - ✔✔not to exceed 2 years
✔✔What is JC appointment timeframe? - ✔✔not to exceed 2 years
✔✔What is the URAC appointment timeframe? - ✔✔every 3 years to the month & day
✔✔As defined by state law who had the appointment timeframe not to exceed 3 years?
- ✔✔URAC
✔✔Who recommends appraisal at least every 24 months if state law does not establsh?
- ✔✔CMS
✔✔Who requires an attestation statement? - ✔✔URAC, HFAP, NCQA
✔✔Who must conduct site visits for complaints & evaluate every 6 months? - ✔✔NCQA
✔✔Who requires CME? - ✔✔JC
✔✔Who requires current competence? - ✔✔TJC, HFAP, AAAHC
✔✔Who says the Governing Board must ensure competence? - ✔✔JC
✔✔Who says if state law requires background checks then they are required? -
✔✔CMS
,✔✔Who allows state licensing board to verify education if the state board verifies the
credentials? - ✔✔URAC
✔✔Who request felony convictions? - ✔✔NCQA, HFAP, AAAHC
✔✔Professional reference must include health status? - ✔✔HFAP
✔✔Does CMS address sanctions? - ✔✔No
✔✔Who allows FSMB to verify license sanctions? - ✔✔JC, NCQA, HFAP
✔✔Malpractice coverage is necessary for what accreditation systems? - ✔✔NCQA,
HFAP, URAC
✔✔Who uses five year history for evaluation of malpractice? - ✔✔NCQA, HFAP
✔✔What is the accepted time limit of malpractice history for URAC? - ✔✔6 Months
✔✔What is the verification time limit for medicare sanctions for NCQA? - ✔✔180 days
✔✔Who has provisional credentialing? - ✔✔NCQA, URAC
✔✔Who has temporary privileges? - ✔✔JC, HFAP
✔✔Who requires peer recommendations? - ✔✔JC, HFAP, AAAHC
✔✔Does NCQA use credentialing committee to make recommendations? - ✔✔Yes
✔✔Can HFAP use credentialing committee to make recommendations? - ✔✔Yes
✔✔Does JC require work history verification? - ✔✔No
✔✔Who on initial appointment review work history for continuity and relevance? -
✔✔AAAHC
✔✔Who requires that all licensed independent practitoners must be credentialed and
privileged through the organized Medical Staff structure? - ✔✔JC
✔✔NCQA current licensure verification time limit of CVO? - ✔✔120 days
✔✔NCQA malpractice verification time limits for CVO? - ✔✔120 days
, ✔✔NCQA time limits on professional liability / malpractice for CVO? - ✔✔Must be
current, valid and verified within 305 calendar days prior to submission to each client
✔✔What is the main reason for periodically assessing appropriateness of clinical
privileges for each specialty? - ✔✔To protect patient safety by ensuring current
competency, revelance to the facility and accepted standards of trade.
✔✔Telemedicine originating site is? - ✔✔Site where the patient is receiving care is
located
✔✔This legislation prohibits a physician with a financial arrangement with an entity from
referring Medicare or Medicaid patients to that entity. - ✔✔Stark Law
✔✔Verification time limit for licensure per NCQA CVO standards? - ✔✔120 days
✔✔Per NCQA standards on initial applications, review of information on sanctions,
restrictions, on licensure and limitations on scope of practice must cover what period of
time? - ✔✔The most recent 5-years
✔✔In the MCO, a review board or Governing Body may review a credentialing decision
after the Credentialing Committee approval. What date does the NCQA use when
assessing performance against timeliness requirements for PSV? - ✔✔Decision date of
the Credentials Committee
✔✔JC approved designated sources for verification against a physician's medical
license? - ✔✔FSMB, State Medical Boards
✔✔This federal law was enacted for the purpose of encouraging good faith professional
review activities: - ✔✔Health Care Quality Improvement Act of 1986 (HCQIA)
✔✔At reappointment NCQA requires 4 factors within prescribed time limits: - ✔✔1. DEA
or CVS\n2. Board Certification\n3. Liability Claims, settled or judgments\n4. Licensure
✔✔What are the CMS criteria for selection to the medical staff? -
✔✔CompetencyCharacter\nJudgment\nExperience Training
✔✔NCQA requires these factors prior to provisional credentialing? - ✔✔Current
license\nPast 5 years of claims, settlements or NPDB report\nApplication with signed
attestation
✔✔AAAHC requires recredentialing every 3 years except for: - ✔✔When state
regulations require less time
