CPCS PRACTICE EXAM QUESTIONS & ANSWERS
Why is it important to check that the practitioner is not currently excluded, suspended,
debarred, or ineligible to participate in Federal health care programs? - Answers - a. A
facility could lose its accreditation if it does not do so
b. It is required by Medicare Conditions or Participation
c. The facility won't get paid for treating patients unless service is provided by an
authorized provider.
Which of the following credentials must be tracked on an ongoing basis? - Answers -
a. Post graduate education completed
b. Closed medical malpractice claims
c. Licensure.
According to NCQA standards, an organization that discovers sanction information,
complaints, or adverse events regarding a practitioner must take what action? -
Answers - a. Determine if there is evidence of poor quality that could affect the health
and safety of its members.
b. Immediately take action to remove the provider from its panel
c. Notify the practitioner that he/she is under investigation and initiate the hearing
process
The Joint Commission hospital standards require that clinical privileges are hospital
specific and... - Answers - a. Based on the individual's demonstrated current
competence and the procedures the hospital can support.
b. Based on board certification
c. Based on the privileges the individual is currently approved to perform at other
hospitals
Which of the following would be routinely performed by a cardiologist? - Answers - a.
Hysterectomy
b. Transesophageal Echocardiography.
c. Urethral dilation
Which NCQA-required committee makes recommendations regarding credentialing
decisions? - Answers - a. Medical Executive Committee
b. Quality Care Committee
c. Credentialing Committee.
HFAP standards require which three medical staff committees to be delineated in the
medical staff structure? - Answers - a. Medical Executive Committee.
b. Utilization of Osteopathic Methods & Concepts Committee. (required for hospitals
with ten or more DOs who admit patients and provide direct patient care)
c. Utilization Review Committee.
d. Credentials Committee
, e. Investigational Review Board
How often does NCQA require that delegation reports be evaluated by the health plan?
- Answers - a. Monthly
b. Quarterly
c. Semi-Annually.
Peer references should be obtained from: - Answers - a. Practitioners who have
referred patients to the provider
b. Former hospital administrators
c. Practitioners in the same professional discipline as the applicant.
NCQA recognizes which of the following as the final approval of an applicant who does
not meet criteria for a clean file? - Answers - a. Medical Director
b. Credentialing Committee.
c. Board of Directors
If a medical staff member has privileges and/or medical staff appointment revoked,
he/she must be: - Answers - a. Granted temporary privileges
b. Provided due process.
c. Reported immediately to the National Practitioner Data Bank
Access to credentials files should be: - Answers - a. Described fully in an access
policy.
b. Available to the organization's patients and potential patients
c. Available to any physician on the staff
Which of the following bodies approves clinical privileges? - Answers - a. Credentials
Committee
b. Medical Executive Committee
c. Governing Body or Board.
What primary source verification is required by NCQA prior to provisional credentialing?
- Answers - a. Licensure and 5-year malpractice history or NPDB.
b. Education and Training
c. Ability to perform privileges requested
According to The Joint Commission standards, initial appointment to the medical staff
are made for a period of: - Answers - a. One year
b. Three years
c. A reasonable time as determined by the medical staff bylaws not to exceed two
years.
According to The Joint Commission standards, temporary privileges may be granted by:
- Answers - a. The department chair
Why is it important to check that the practitioner is not currently excluded, suspended,
debarred, or ineligible to participate in Federal health care programs? - Answers - a. A
facility could lose its accreditation if it does not do so
b. It is required by Medicare Conditions or Participation
c. The facility won't get paid for treating patients unless service is provided by an
authorized provider.
Which of the following credentials must be tracked on an ongoing basis? - Answers -
a. Post graduate education completed
b. Closed medical malpractice claims
c. Licensure.
According to NCQA standards, an organization that discovers sanction information,
complaints, or adverse events regarding a practitioner must take what action? -
Answers - a. Determine if there is evidence of poor quality that could affect the health
and safety of its members.
b. Immediately take action to remove the provider from its panel
c. Notify the practitioner that he/she is under investigation and initiate the hearing
process
The Joint Commission hospital standards require that clinical privileges are hospital
specific and... - Answers - a. Based on the individual's demonstrated current
competence and the procedures the hospital can support.
b. Based on board certification
c. Based on the privileges the individual is currently approved to perform at other
hospitals
Which of the following would be routinely performed by a cardiologist? - Answers - a.
Hysterectomy
b. Transesophageal Echocardiography.
c. Urethral dilation
Which NCQA-required committee makes recommendations regarding credentialing
decisions? - Answers - a. Medical Executive Committee
b. Quality Care Committee
c. Credentialing Committee.
HFAP standards require which three medical staff committees to be delineated in the
medical staff structure? - Answers - a. Medical Executive Committee.
b. Utilization of Osteopathic Methods & Concepts Committee. (required for hospitals
with ten or more DOs who admit patients and provide direct patient care)
c. Utilization Review Committee.
d. Credentials Committee
, e. Investigational Review Board
How often does NCQA require that delegation reports be evaluated by the health plan?
- Answers - a. Monthly
b. Quarterly
c. Semi-Annually.
Peer references should be obtained from: - Answers - a. Practitioners who have
referred patients to the provider
b. Former hospital administrators
c. Practitioners in the same professional discipline as the applicant.
NCQA recognizes which of the following as the final approval of an applicant who does
not meet criteria for a clean file? - Answers - a. Medical Director
b. Credentialing Committee.
c. Board of Directors
If a medical staff member has privileges and/or medical staff appointment revoked,
he/she must be: - Answers - a. Granted temporary privileges
b. Provided due process.
c. Reported immediately to the National Practitioner Data Bank
Access to credentials files should be: - Answers - a. Described fully in an access
policy.
b. Available to the organization's patients and potential patients
c. Available to any physician on the staff
Which of the following bodies approves clinical privileges? - Answers - a. Credentials
Committee
b. Medical Executive Committee
c. Governing Body or Board.
What primary source verification is required by NCQA prior to provisional credentialing?
- Answers - a. Licensure and 5-year malpractice history or NPDB.
b. Education and Training
c. Ability to perform privileges requested
According to The Joint Commission standards, initial appointment to the medical staff
are made for a period of: - Answers - a. One year
b. Three years
c. A reasonable time as determined by the medical staff bylaws not to exceed two
years.
According to The Joint Commission standards, temporary privileges may be granted by:
- Answers - a. The department chair
