CPCS FBQ UPDATED ACTUAL Exam
Questions and CORRECT Answers
Per NCQA, health plans are required to credential locums tenens working for more than 90 days.
- CORRECT 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? - CORRECT
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. - CORRECT ANSWER - True
What are the two elements of Due Process? - CORRECT ANSWER - Substantive and
Procedural
Peer references are required as part of the health plan credentialing process. - CORRECT
ANSWER - False
What is TJC? - CORRECT 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. - CORRECT ANSWER - True
Per NCQA how far back do you verify Medicare and Medicaid sanctions? - CORRECT
ANSWER - Most recent 5 year history
,Which of the following is or are appropriate sources for verification of Foreign Medical
Education Graduates? - CORRECT ANSWER - ECFMG
The final decision-making body for a health plan is the Governing body. - CORRECT
ANSWER - False
Does NCQA requires a practitioner to hold malpractice insurance? - CORRECT
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. - CORRECT 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. - CORRECT 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. - CORRECT ANSWER - True
Which of the following accepts a malpractice insurance statement and attestation as proof of
liability insurance? - CORRECT ANSWER - NCQA
Which term describes a step by step sequence for proper completion of a task? - CORRECT
ANSWER - Procedure
If an applicant has completed a residency program that is not recognized by NCQA, then the
medical school must be verified - CORRECT ANSWER - True
, Which of the following bodies approves clinical privileges? - CORRECT 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. - CORRECT
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. - CORRECT
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? - CORRECT ANSWER - The
facility won't get paid for treating patients unless service is provided by authorized provider.
Who is required to query the NPDB? - CORRECT ANSWER - Hospitals
According to NCQA what providers are NOT required to be credentialed when working in an
independent relationship? - CORRECT 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? - CORRECT ANSWER - Residency
True or false: Using the ABMS "Certification Matters" link on its website is considered a
primary source. - CORRECT ANSWER - False
Managed Care Credentialing
Verification of hospital admitting privileges may be required by: - CORRECT ANSWER -
CMS
Questions and CORRECT Answers
Per NCQA, health plans are required to credential locums tenens working for more than 90 days.
- CORRECT 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? - CORRECT
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. - CORRECT ANSWER - True
What are the two elements of Due Process? - CORRECT ANSWER - Substantive and
Procedural
Peer references are required as part of the health plan credentialing process. - CORRECT
ANSWER - False
What is TJC? - CORRECT 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. - CORRECT ANSWER - True
Per NCQA how far back do you verify Medicare and Medicaid sanctions? - CORRECT
ANSWER - Most recent 5 year history
,Which of the following is or are appropriate sources for verification of Foreign Medical
Education Graduates? - CORRECT ANSWER - ECFMG
The final decision-making body for a health plan is the Governing body. - CORRECT
ANSWER - False
Does NCQA requires a practitioner to hold malpractice insurance? - CORRECT
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. - CORRECT 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. - CORRECT 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. - CORRECT ANSWER - True
Which of the following accepts a malpractice insurance statement and attestation as proof of
liability insurance? - CORRECT ANSWER - NCQA
Which term describes a step by step sequence for proper completion of a task? - CORRECT
ANSWER - Procedure
If an applicant has completed a residency program that is not recognized by NCQA, then the
medical school must be verified - CORRECT ANSWER - True
, Which of the following bodies approves clinical privileges? - CORRECT 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. - CORRECT
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. - CORRECT
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? - CORRECT ANSWER - The
facility won't get paid for treating patients unless service is provided by authorized provider.
Who is required to query the NPDB? - CORRECT ANSWER - Hospitals
According to NCQA what providers are NOT required to be credentialed when working in an
independent relationship? - CORRECT 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? - CORRECT ANSWER - Residency
True or false: Using the ABMS "Certification Matters" link on its website is considered a
primary source. - CORRECT ANSWER - False
Managed Care Credentialing
Verification of hospital admitting privileges may be required by: - CORRECT ANSWER -
CMS
