CPCS Knowledge 2 — Questions and Answers
Question 1: Which organization publishes the USMLE Step examinations used to verify physician competency?
- National Board of Medical Examiners (NBME) and FSMB jointly (Correct answer)
- American Medical Association (AMA)
- Accreditation Council for Graduate Medical Education (ACGME)
- Joint Commission on Allied Health Personnel in Ophthalmology
Correct answer: National Board of Medical Examiners (NBME) and FSMB jointly
The USMLE is co-sponsored by the NBME and the Federation of State Medical Boards (FSMB).
Question 2: What is the primary purpose of the National Practitioner Data Bank (NPDB) in the credentialing process?
- To store DEA registration numbers for all practitioners
- To provide a repository of adverse actions and malpractice payments for query during credentialing (Correct answer)
- To issue medical licenses on behalf of state boards
- To certify graduate medical education programs
Correct answer: To provide a repository of adverse actions and malpractice payments for query during credentialing
The NPDB is a federal repository that credentialers query to identify adverse licensure actions, malpractice payments, and clinical privilege restrictions.
Question 3: Under NCQA standards, how often must a healthcare organization re-credential its participating practitioners?
- Annually
- Every 2 years
- Every 3 years (Correct answer)
- Every 5 years
Correct answer: Every 3 years
NCQA requires re-credentialing at least every 36 months (3 years) to maintain accreditation.
Question 4: Which document formally delegates credentialing authority from a hospital's governing board to the medical staff?
- Bylaws (Correct answer)
- Credentialing policy manual
- Participation agreement
- Joint operating agreement
Correct answer: Bylaws
Hospital bylaws define the structure through which the governing board delegates credentialing and privileging decisions to the medical staff.
Question 5: A practitioner's application lists a gap in work history of 14 months. Per best credentialing practice, what should the credentialing specialist do?
- Approve the application since gaps under 2 years are acceptable
- Automatically deny the application
- Request a written explanation and supporting documentation from the practitioner (Correct answer)
- Forward directly to peer review without further verification
Correct answer: Request a written explanation and supporting documentation from the practitioner
Unexplained employment gaps must be addressed by requesting a written explanation and any relevant documentation before the file advances.
Question 6: Which accrediting body specifically governs credentialing standards for managed care organizations and health plans?
- The Joint Commission (TJC)
- Det Norske Veritas (DNV)
- National Committee for Quality Assurance (NCQA) (Correct answer)
- Accreditation Association for Ambulatory Health Care (AAAHC)
Correct answer: National Committee for Quality Assurance (NCQA)
NCQA's credentialing standards are the primary benchmark for health plans and managed care organizations.
Question 7: What does 'primary source verification' mean in credentialing?
- Reviewing the practitioner's self-reported application data
- Confirming credentials directly with the original issuing organization (Correct answer)
- Using a third-party credentialing verification organization (CVO) to collect documents
- Checking a practitioner's credentials against a peer-reviewed database
Correct answer: Confirming credentials directly with the original issuing organization
Primary source verification requires confirming credential information directly with the entity that granted the credential (e.g., the medical school itself).
