Certified Provider Credentialing Specialist (CPCS) Study Guide

Certified Provider Credentialing Specialist (CPCS) Study Guide Certified Provider Credentialing Specialist - The Certified Provider Credentialing Specialist (CPCS) is typically employed or contracted by a healthcare organization including, but not limited to, hospitals (health systems), health plans, ambulatory care settings, group practices, and credentialing verification organizations. Initial Appointment / Clinical privileges/ practioners covered according to the TJC - All licensed Independent practitioners must be credentialed and privileged through the organized Medical staff structure Initial Appointment / Clinical privileges/ practioners covered according to the NCQA - HP's and MBHO's must have documented Credentialing policies and procedures that apply to all practitioners who provide care to the organizations members Initial Appointment / Clinical privileges/ practioners covered according to CMS - The Governing body determines, in accordance with Staye Law, which categories of practitioners are eligible for appointment to the medical staff. At a minimum the medical staff must be composed of MD 's and DO's. Verification of Medical education according to the TJC - Requires verification from the medical school or accepted PSV TJC Accepted PSV for medical education - The AMA, the AOA, and the ECFMG Verification of Medical education according to the NCQA - Requires HP/CVO the highest of three levels of education and training. The three levels of education and training as defined by NCQA - Graduation from medical or professional school, residency, board certification. Verification of Medical education according to CMS - The medical staff must have a mechanism to examine evidence of professional education Verification of postgraduate training according to TJC - Requires verification from the primary source or designated equivalent sources. TJC accepted PSV for postgraduate training - AMA and AOA Verification of postgraduate training according to NCQA - The highest of the three levels of education and training attained. If board certified, than board certification suffices. Verification of postgraduate training according to CMS - The medical staff must have a mechanism to examine evidence of training and documented experiences. Continues...