CPCS - Certified Provider Credentialing Specialist Exam Study Questions 2022 96 Questions with 100% Correct Answers – COMPLETE SOLUTION Are limitations of the clinical privileges of a psychiatris... t for more than 30 days reportable to the NPDB? - ✔✔Yes According to TJC, who may amend the medical staff bylaws? - ✔✔Governing body/board. Failure to meet the established qualifications and criteria for appointment should be reported to whom? - ✔✔The applicant NCQA requires the MCO to obtain a minimum of how may years of work history? - ✔✔Five years According to the NCQA what policy must an organization have in place to obtain approval to enter into a delegated agreement? - ✔✔Credentialing policies How often does the OIG report to the NPDB? - ✔✔Monthly When must hospitals query the NPDB? - ✔✔Initial appointment, granting of privileges, every two years. NCQA requires verifications must be less than how many days old? - ✔✔180 days What is the verification time limit on malpractice history according to the NCQA? - ✔✔180 days Time limited credential must be verified by the CVO with how may days prior to submission to the client? - ✔✔120 days According the AAAHC, for initial appointments, in addition to licensure and education, what verification is required? - ✔✔Experience and hospital affiliations.What accreditation body states "The NPDB is an acceptable source for sanctions or limitations on licensure, Medicaid/ Medicare sanctions and malpractice history? - ✔✔NCQA Who is required to query the NPDB? - ✔✔Hospitals Is disciplinary action taken against the license of a dentist reportable to the NPDB? - ✔✔Yes 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? - ✔✔3 years According to NCQA, verification of Medicare/Medicaid sanctions can be queried by any of what sources? - ✔✔AMA, FSMB, HIPDB, OIG Sanctions Report, NPDB, State Agency According to NCQA, how often must an organization conduct an audit of the credentialing process delegated to another organization? - ✔✔Annually How far back does TJC require evaluation of malpractice history? - ✔✔Back to medical school According to TJC, what source may be used to evaluate malpractice history? - ✔✔NPDB Is an internet verification from a website not contracted by the primary source that attests to the accuracy and timeliness of the information considered a complete verification by NCQA? - ✔✔No What accreditation bodies require privileges to be distributed to essential department personnel? - ✔✔TJC, CMS TJC and NCQA do not require criminal background checks. - ✔✔True Is a payment made by an insurance company reportable to the NPDB? - ✔✔YesWho is the best person to consult when releasing adverse information in a verification request from another organization? - ✔✔Legal counsel According to CMS, who in the organization may make decisions regarding approval of credentialing applications? - ✔✔Governing body/board. According to the NCQA what providers are NOT required to be credentialed when working in an independent relationship? - ✔✔Locums Tenens, hospital based practitioners How many peer references does HFAP require at initial appointment? - ✔✔One Denial of a medical license application by a state medical board is not reportable to the NPDB. (T/F) - ✔✔True Which two accreditors state a hospital may not rely solely on board certi [Show More]
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