CPCS 2026 STUDY EXAMS GUIDE QUESTIONS AND
ANSWERS SURE A+
✔✔Secondary source allowed... - ✔✔URAC - Verify based on evidence obtained by
other means that direct contact with issuing source
AAAHC - report from agency that performs PSV
✔✔When must practitioners be notified of initial decision/recredentialing denial? NCQA
- ✔✔60 calendar days of committee decision
✔✔PSV timing NCQA - ✔✔Counts backwards from date of credentialing
✔✔Delegated credentialing on site quality audits - frequency - URAC - ✔✔On site
survey every 3 years
✔✔Delegated credentialing - NCQA - ✔✔Organization completes pre-delegation audit
Delegation agreement has description of functions, activities, reporting requirements,e
valuation of entity's performance
Annual review of delegate's credentialing P&Ps
✔✔Delegated credentialing - AAAHC - ✔✔Use of CVO is allowed
Org must perform assessment of CVO
Accreditation of CVO by nationally recognized org meets this requirement
✔✔PCO - meaning and used by - ✔✔Professional Credentialing Organization
HFAP to perform PSV
✔✔If delegated entity is NCQA certified/accredited - NCQA - ✔✔Annual review does not
require review of elements for which CVO is certified (e.g. PSV of licensure)
✔✔Delegated credentialing - Medicare deeming - NCQA - ✔✔Delegation agreement
must include statement requiring delegate to adhere to Medicare regulations
May include additional reqs (semi-annual report)
✔✔When must practitioners be notified of initial decision/recredentialing denial? URAC -
✔✔10 business days from decision (written)
✔✔Committee must make recommendation to MEC when - HFAP - ✔✔within 60 days
of receipt of completed application
✔✔Committee meeting frequency requirements - ✔✔URAC - at least quarterly
HFAP - hospital determines
, ✔✔Governing body - ✔✔Board
Ultimate authority
Legally responsible
Oversight of credentialing and privileging
✔✔Break in service of X days requires initial credential, rather than recredential - NCQA
- ✔✔30 days
✔✔Provider with DEA certificate pending - NCQA - ✔✔NCQA allows organization to
credential provider with pending DEA if documented process to allow provider w/DEA to
write prescriptions
✔✔Residency/Fellowship Training - TJC - ✔✔Primary source: training program
Designated Equivalent Source:
- AMA
-AOA
✔✔Verify closed residency program - NCQA - ✔✔FCVS
✔✔When is residency verification required? - ✔✔Only initial
✔✔PSV for residency/fellowship training - HFAP - ✔✔Direct contact with program
AMA
AOA
✔✔Recongnized residency programs - NCQA - ✔✔ONLY programs accreditted by
ACGME, College of Family Physicians of Canada, or Royal College of Physicians and
Surgeons of Canada
✔✔ACGME - ✔✔Accreditation Council of Graduate Medical Education
Accredits GMEs
✔✔Residency PSV - NCQA - ✔✔- Primary source from residency program
- State licensing agency (PSV rule)
- Sealed transcript (document org opened it)
- AMA
- AOA
- FCVS for closed residency programs
✔✔Residency PSV - URAC - ✔✔- Primary source from residency program
- State licensing agency (PSV rule)
ANSWERS SURE A+
✔✔Secondary source allowed... - ✔✔URAC - Verify based on evidence obtained by
other means that direct contact with issuing source
AAAHC - report from agency that performs PSV
✔✔When must practitioners be notified of initial decision/recredentialing denial? NCQA
- ✔✔60 calendar days of committee decision
✔✔PSV timing NCQA - ✔✔Counts backwards from date of credentialing
✔✔Delegated credentialing on site quality audits - frequency - URAC - ✔✔On site
survey every 3 years
✔✔Delegated credentialing - NCQA - ✔✔Organization completes pre-delegation audit
Delegation agreement has description of functions, activities, reporting requirements,e
valuation of entity's performance
Annual review of delegate's credentialing P&Ps
✔✔Delegated credentialing - AAAHC - ✔✔Use of CVO is allowed
Org must perform assessment of CVO
Accreditation of CVO by nationally recognized org meets this requirement
✔✔PCO - meaning and used by - ✔✔Professional Credentialing Organization
HFAP to perform PSV
✔✔If delegated entity is NCQA certified/accredited - NCQA - ✔✔Annual review does not
require review of elements for which CVO is certified (e.g. PSV of licensure)
✔✔Delegated credentialing - Medicare deeming - NCQA - ✔✔Delegation agreement
must include statement requiring delegate to adhere to Medicare regulations
May include additional reqs (semi-annual report)
✔✔When must practitioners be notified of initial decision/recredentialing denial? URAC -
✔✔10 business days from decision (written)
✔✔Committee must make recommendation to MEC when - HFAP - ✔✔within 60 days
of receipt of completed application
✔✔Committee meeting frequency requirements - ✔✔URAC - at least quarterly
HFAP - hospital determines
, ✔✔Governing body - ✔✔Board
Ultimate authority
Legally responsible
Oversight of credentialing and privileging
✔✔Break in service of X days requires initial credential, rather than recredential - NCQA
- ✔✔30 days
✔✔Provider with DEA certificate pending - NCQA - ✔✔NCQA allows organization to
credential provider with pending DEA if documented process to allow provider w/DEA to
write prescriptions
✔✔Residency/Fellowship Training - TJC - ✔✔Primary source: training program
Designated Equivalent Source:
- AMA
-AOA
✔✔Verify closed residency program - NCQA - ✔✔FCVS
✔✔When is residency verification required? - ✔✔Only initial
✔✔PSV for residency/fellowship training - HFAP - ✔✔Direct contact with program
AMA
AOA
✔✔Recongnized residency programs - NCQA - ✔✔ONLY programs accreditted by
ACGME, College of Family Physicians of Canada, or Royal College of Physicians and
Surgeons of Canada
✔✔ACGME - ✔✔Accreditation Council of Graduate Medical Education
Accredits GMEs
✔✔Residency PSV - NCQA - ✔✔- Primary source from residency program
- State licensing agency (PSV rule)
- Sealed transcript (document org opened it)
- AMA
- AOA
- FCVS for closed residency programs
✔✔Residency PSV - URAC - ✔✔- Primary source from residency program
- State licensing agency (PSV rule)
