1|Page
CPCS EXAM AND STUDY GUIDE NEWEST 2025 TEST
BANK| CERTIFIED PROVIDER CREDENTIALING
SPECIALIST FINAL EXAM PREP WITH 650 REAL
EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+ (BRAND NEW!!)
What is the verification time limit on malpractice history according to
the NCQA? - ANSWER - 180 days
Time limited credential must be verified by the CVO with how may days
prior to submission to the client? - ANSWER - 120 days
According the AAAHC, for initial appointments, in addition to licensure
and education, what verification is required? - ANSWER - Experience
and hospital affiliations.
Who is required to query the NPDB? - ANSWER - Hospitals
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? - ANSWER - 3 years
According to NCQA, verification of Medicare/Medicaid sanctions can
be queried by any of what sources? - ANSWER - AMA, FSMB, HIPDB,
OIG Sanctions Report, NPDB, State Agency
pg. 1
,2|Page
According to NCQA, how often must an organization conduct an audit
of the credentialing process delegated to another organization? -
ANSWER - Annually
How far back does TJC require evaluation of malpractice history? -
ANSWER - Back to medical school
According to TJC, what source may be used to evaluate malpractice
history? - ANSWER - NPDB
The case of Darling versus Charleston Memorial community Hospital
was significant in that it set aside a long-standing doctrine that was
applied to hospitals. What is this doctrine? - ANSWER - Charitable
immunity doctrine
NCQA utilizes what date when assessing compliance with timeliness
requirements for PSV - ANSWER - The credentials committee or
medical Director sign off on clean files
What is the federal law that was enacted for the purpose of encouraging
good faith, professional review activities? - ANSWER - Healthcare
quality improvement act of 1986 the HCQIA
Which body states surgical privileges shall correspond with the
established competencies of each practitioner? - ANSWER - DNV
pg. 2
,3|Page
Who requires that the applicants ability to perform privileges requested
must be evaluated and this evaluation documented in the credentials
file? - ANSWER - TJC
Who states references should include a statement regarding the
physicians, physical and mental health in relation to privileges
requested? - ANSWER - HFAP
Who states application includes disclosure of any physical, mental or
substance abuse problems? - ANSWER - URAC
The DNV's surveyor guidance section mirrors, who? - ANSWER -
Medicare COP's
Which bodies use the term Allied health professionals? - ANSWER -
URAC and AAAHC
The joint commission states any individual permitted by law, and by the
organization to provide care, treatment, and services without direction,
or supervision is known as what? - ANSWER - Licensed independent
practitioner
If allowed by the organization who states the board must provide a
process for the initial appointment, reappointment, assignment, or
curtailment of privileges, and practice for AHP's? - ANSWER - AAAHC
pg. 3
, 4|Page
Who requires a current signed attestation from applicant, regarding the
reasons for any inability to perform essential functions of the position,
with or without accommodation, and the lack of present legal drug use? -
ANSWER - NCQA
TJ C states all LIP, PAs, and APRN, who are providing a medical level
of care are credentialed and privileged through? - ANSWER - The
medical staff process
Who requires a mechanism to determine the applicant is the individual
identified in the credentialing documents by viewing either a current
picture hospital ID card or a valid picture ID issued by a state or federal
agency example drivers license or passport? - ANSWER - TJC
Which accrediting bodies appointment timeframe requirements are a
direct quote from CMS? - ANSWER - HFAP
Which accrediting bodies recredential at least every three years and
counts the three-year cycle to the month and not the day? - ANSWER -
NCQA and URAC
Appointment time frames with which accrediting body are defined by
state law and organizational policy and are not too exceeded three years?
- ANSWER - AAAHC
pg. 4
CPCS EXAM AND STUDY GUIDE NEWEST 2025 TEST
BANK| CERTIFIED PROVIDER CREDENTIALING
SPECIALIST FINAL EXAM PREP WITH 650 REAL
EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+ (BRAND NEW!!)
What is the verification time limit on malpractice history according to
the NCQA? - ANSWER - 180 days
Time limited credential must be verified by the CVO with how may days
prior to submission to the client? - ANSWER - 120 days
According the AAAHC, for initial appointments, in addition to licensure
and education, what verification is required? - ANSWER - Experience
and hospital affiliations.
Who is required to query the NPDB? - ANSWER - Hospitals
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? - ANSWER - 3 years
According to NCQA, verification of Medicare/Medicaid sanctions can
be queried by any of what sources? - ANSWER - AMA, FSMB, HIPDB,
OIG Sanctions Report, NPDB, State Agency
pg. 1
,2|Page
According to NCQA, how often must an organization conduct an audit
of the credentialing process delegated to another organization? -
ANSWER - Annually
How far back does TJC require evaluation of malpractice history? -
ANSWER - Back to medical school
According to TJC, what source may be used to evaluate malpractice
history? - ANSWER - NPDB
The case of Darling versus Charleston Memorial community Hospital
was significant in that it set aside a long-standing doctrine that was
applied to hospitals. What is this doctrine? - ANSWER - Charitable
immunity doctrine
NCQA utilizes what date when assessing compliance with timeliness
requirements for PSV - ANSWER - The credentials committee or
medical Director sign off on clean files
What is the federal law that was enacted for the purpose of encouraging
good faith, professional review activities? - ANSWER - Healthcare
quality improvement act of 1986 the HCQIA
Which body states surgical privileges shall correspond with the
established competencies of each practitioner? - ANSWER - DNV
pg. 2
,3|Page
Who requires that the applicants ability to perform privileges requested
must be evaluated and this evaluation documented in the credentials
file? - ANSWER - TJC
Who states references should include a statement regarding the
physicians, physical and mental health in relation to privileges
requested? - ANSWER - HFAP
Who states application includes disclosure of any physical, mental or
substance abuse problems? - ANSWER - URAC
The DNV's surveyor guidance section mirrors, who? - ANSWER -
Medicare COP's
Which bodies use the term Allied health professionals? - ANSWER -
URAC and AAAHC
The joint commission states any individual permitted by law, and by the
organization to provide care, treatment, and services without direction,
or supervision is known as what? - ANSWER - Licensed independent
practitioner
If allowed by the organization who states the board must provide a
process for the initial appointment, reappointment, assignment, or
curtailment of privileges, and practice for AHP's? - ANSWER - AAAHC
pg. 3
, 4|Page
Who requires a current signed attestation from applicant, regarding the
reasons for any inability to perform essential functions of the position,
with or without accommodation, and the lack of present legal drug use? -
ANSWER - NCQA
TJ C states all LIP, PAs, and APRN, who are providing a medical level
of care are credentialed and privileged through? - ANSWER - The
medical staff process
Who requires a mechanism to determine the applicant is the individual
identified in the credentialing documents by viewing either a current
picture hospital ID card or a valid picture ID issued by a state or federal
agency example drivers license or passport? - ANSWER - TJC
Which accrediting bodies appointment timeframe requirements are a
direct quote from CMS? - ANSWER - HFAP
Which accrediting bodies recredential at least every three years and
counts the three-year cycle to the month and not the day? - ANSWER -
NCQA and URAC
Appointment time frames with which accrediting body are defined by
state law and organizational policy and are not too exceeded three years?
- ANSWER - AAAHC
pg. 4
