CPCS Accreditation Standards and Compliance 2 — Questions and Answers
Question 1: Which accrediting body specifically focuses on managed care organizations and requires credentialing standards as part of its NCQA accreditation process?
- The Joint Commission (TJC)
- National Committee for Quality Assurance (NCQA) (Correct answer)
- URAC
- DNV GL Healthcare
Correct answer: National Committee for Quality Assurance (NCQA)
NCQA accreditation for health plans includes rigorous credentialing and recredentialing standards that managed care organizations must meet.
Question 2: Under URAC credentialing standards, what is the maximum acceptable time frame for completing a credentialing decision once an application is deemed complete?
- 30 days
- 60 days
- 90 days (Correct answer)
- 180 days
Correct answer: 90 days
URAC standards generally require that credentialing decisions be completed within 90 days of receiving a complete application.
Question 3: A hospital's medical staff bylaws conflict with a newly adopted accreditation standard. Which action should the credentialing specialist recommend first?
- Ignore the accreditation standard until the next survey
- Amend the bylaws through the medical staff governance process (Correct answer)
- Apply the accreditation standard without updating the bylaws
- Request a waiver from the accrediting body immediately
Correct answer: Amend the bylaws through the medical staff governance process
Bylaws must be updated through proper governance channels to align with accreditation standards, ensuring legal and procedural compliance.
Question 4: Which element is NOT typically required by accreditation standards during the initial credentialing process?
- Verification of medical school education
- Review of malpractice history
- Submission of a five-year financial disclosure statement (Correct answer)
- Current DEA registration if applicable
Correct answer: Submission of a five-year financial disclosure statement
Financial disclosure statements are not a standard credentialing requirement; education, malpractice history, and DEA registration are routinely verified.
Question 5: CMS Conditions of Participation require hospitals to grant temporary privileges in which specific circumstance?
- When a provider requests expedited review for elective procedures
- To meet important patient care needs when a complete credentialing file is pending (Correct answer)
- For all new providers automatically upon hire
- Only for providers credentialed at a sister facility
Correct answer: To meet important patient care needs when a complete credentialing file is pending
CMS allows temporary privileges when there is an important patient care need and the full credentialing process has not yet been completed.
Question 6: Which accreditation standard concept requires that a provider's privileges be matched to their demonstrated current competency rather than solely their training?
- Focused Professional Practice Evaluation (FPPE)
- Ongoing Professional Practice Evaluation (OPPE)
- Privilege Delineation (Correct answer)
- Proctoring Requirements
Correct answer: Privilege Delineation
Privilege delineation ensures that each specific clinical privilege granted reflects the provider's demonstrated ability to perform that procedure or service.
Question 7: Under The Joint Commission standards, how often must a hospital's credentialing and privileging policies be reviewed and updated?
- Every year
- Every two years (Correct answer)
- Every three years
- Every five years
Correct answer: Every two years
TJC requires that medical staff bylaws, rules, regulations, and policies—including credentialing policies—be reviewed and updated at least every two years.
