CPCS FBQ EXAM QUESTIONS AND
100% VERIFIED ANSWERS
Per NCQA, health plans are required to credential locums tenens working for
more than 90 days. - ANSWER False - but with a caveat, only Locum Tenens
who have an independent relationship with the organization must be
credentialed if they serve in this capacity for more than ninety (90) calendar
days.
How often does URAC require that delegation oversight audits be performed? -
ANSWER every 3 years an on- site survey must be conducted or there must be
a process for randomly- selecting files which must be provided to the
organization for review within a specified amount of time
Hospital Due Process must follow HCQIA to be protected. - ANSWER True
What are the two elements of Due Process? - ANSWER Substantive and
Procedural
Peer references are required as part of the health plan credentialing process. -
ANSWER False
What is TJC? - ANSWER A not-for-profit organization that provides
accreditation of healthcare organizations
NCQA required a minimum of most recent five year work history reviewed at
initial credentialing. If the practitioner has fewer than 5 years of work history,
the time frame starts at the initial licensure date. - ANSWER True
Per NCQA how far back do you verify Medicare and Medicaid sanctions? -
ANSWER Most recent 5 year history
Which of the following is or are appropriate sources for verification of Foreign
Medical Education Graduates? - ANSWER ECFMG
,The final decision-making body for a health plan is the Governing body. -
ANSWER False
Does NCQA requires a practitioner to hold malpractice insurance? - ANSWER
No. Health plans usually require malpractice insurance, but this is not an NCQA
Requirement. Per NCQA the applicant must disclose on the application if they
hold coverage.
The timeframe between credentialing cycles cannot exceed 36 months from the
previous credentialing committee date. - ANSWER True
T/F NCQA Standards Work History.
Any gap of 6 months or more require explanation verbally or in writing. Any
gap that exceeds 1 year require written explanation. - ANSWER True
NCQA does not require verification of board certification for nurse practitioners
or other healthcare professionals unless board certification status is included in
the health plan's member directory or on its website. - ANSWER True
Which of the following accepts a malpractice insurance statement and
attestation as proof of liability insurance? - ANSWER NCQA
Which term describes a step by step sequence for proper completion of a task? -
ANSWER Procedure
If an applicant has completed a residency program that is not recognized by
NCQA, then the medical school must be verified - ANSWER True
Which of the following bodies approves clinical privileges? - ANSWER
Governing Body or Board
Per URAC standards, if the board certification doesn't have an expiration date,
then the health plan is only required to verify the certification at initial
credentialing. - ANSWER True
Some states do require a criminal background check for members of medical
staffs or individuals privileged through the medical staff. The joint Commission
, requires organizations to comply with all applicable state and federal
regulations and requirements. - ANSWER True
Why it is important to check that the practitioner is not currently excluded,
suspended, debarred, or ineligible to participate in Federal health care
programs? - ANSWER The facility won't get paid for treating patients unless
service is provided by authorized provider.
Who is required to query the NPDB? - ANSWER Hospitals
According to NCQA what providers are NOT required to be credentialed when
working in an independent relationship? - ANSWER NCQA states you must
credential all practitioners whom the organization has an independent
relationship.
Which of the following verifications does NCQA require for a non-board-
certified interventional
cardiologist? - ANSWER Residency
True or false: Using the ABMS "Certification Matters" link on its website is
considered a primary source. - ANSWER False
Managed Care Credentialing
Verification of hospital admitting privileges may be required by: - ANSWER
CMS
Which of the following accreditation standards have time limits? - ANSWER
URAC and NCQA
True or false:
Managed Care Credentialing.
Querying the National Practitioner Data Bank meets the minimum requirement
to
verify the past five years of malpractice history. - ANSWER True
Managed Care Credentialing
100% VERIFIED ANSWERS
Per NCQA, health plans are required to credential locums tenens working for
more than 90 days. - ANSWER False - but with a caveat, only Locum Tenens
who have an independent relationship with the organization must be
credentialed if they serve in this capacity for more than ninety (90) calendar
days.
How often does URAC require that delegation oversight audits be performed? -
ANSWER every 3 years an on- site survey must be conducted or there must be
a process for randomly- selecting files which must be provided to the
organization for review within a specified amount of time
Hospital Due Process must follow HCQIA to be protected. - ANSWER True
What are the two elements of Due Process? - ANSWER Substantive and
Procedural
Peer references are required as part of the health plan credentialing process. -
ANSWER False
What is TJC? - ANSWER A not-for-profit organization that provides
accreditation of healthcare organizations
NCQA required a minimum of most recent five year work history reviewed at
initial credentialing. If the practitioner has fewer than 5 years of work history,
the time frame starts at the initial licensure date. - ANSWER True
Per NCQA how far back do you verify Medicare and Medicaid sanctions? -
ANSWER Most recent 5 year history
Which of the following is or are appropriate sources for verification of Foreign
Medical Education Graduates? - ANSWER ECFMG
,The final decision-making body for a health plan is the Governing body. -
ANSWER False
Does NCQA requires a practitioner to hold malpractice insurance? - ANSWER
No. Health plans usually require malpractice insurance, but this is not an NCQA
Requirement. Per NCQA the applicant must disclose on the application if they
hold coverage.
The timeframe between credentialing cycles cannot exceed 36 months from the
previous credentialing committee date. - ANSWER True
T/F NCQA Standards Work History.
Any gap of 6 months or more require explanation verbally or in writing. Any
gap that exceeds 1 year require written explanation. - ANSWER True
NCQA does not require verification of board certification for nurse practitioners
or other healthcare professionals unless board certification status is included in
the health plan's member directory or on its website. - ANSWER True
Which of the following accepts a malpractice insurance statement and
attestation as proof of liability insurance? - ANSWER NCQA
Which term describes a step by step sequence for proper completion of a task? -
ANSWER Procedure
If an applicant has completed a residency program that is not recognized by
NCQA, then the medical school must be verified - ANSWER True
Which of the following bodies approves clinical privileges? - ANSWER
Governing Body or Board
Per URAC standards, if the board certification doesn't have an expiration date,
then the health plan is only required to verify the certification at initial
credentialing. - ANSWER True
Some states do require a criminal background check for members of medical
staffs or individuals privileged through the medical staff. The joint Commission
, requires organizations to comply with all applicable state and federal
regulations and requirements. - ANSWER True
Why it is important to check that the practitioner is not currently excluded,
suspended, debarred, or ineligible to participate in Federal health care
programs? - ANSWER The facility won't get paid for treating patients unless
service is provided by authorized provider.
Who is required to query the NPDB? - ANSWER Hospitals
According to NCQA what providers are NOT required to be credentialed when
working in an independent relationship? - ANSWER NCQA states you must
credential all practitioners whom the organization has an independent
relationship.
Which of the following verifications does NCQA require for a non-board-
certified interventional
cardiologist? - ANSWER Residency
True or false: Using the ABMS "Certification Matters" link on its website is
considered a primary source. - ANSWER False
Managed Care Credentialing
Verification of hospital admitting privileges may be required by: - ANSWER
CMS
Which of the following accreditation standards have time limits? - ANSWER
URAC and NCQA
True or false:
Managed Care Credentialing.
Querying the National Practitioner Data Bank meets the minimum requirement
to
verify the past five years of malpractice history. - ANSWER True
Managed Care Credentialing
