CPCS Credentialing and Privileging Practice Test

These questions are part of the practice quiz. Start practicing

• Three reasons for Credentialing include
• In inpatient settings, the threshold for locum tenens duration mentioned is how many days?
• The HIPDB revision incorporated statutory requirements under which section of the Social Security Act?
• Which accreditation defines credentialing as the process by which an organization reviews and evaluates the qualifications of licensed independent practitioners to provide services to its members?
• Who may the Medical staff delegate authority to for changing the hospital's Rules & Regulations?
• Which statement correctly links credentialing to patient safety?
• Which accreditation is most closely associated with ambulatory care facilities?
• Which accreditation requires all participating providers and facilities that deliver covered health care services to consumers to credential all practitioners listed in the directory?
• Which term describes requirements set by forces outside the organization, such as accreditation bodies and government regulations?
• The Medical Staff Bylaws, or credentials manual indicate requirements for PSV?
• Which legislative provision is cited as the reason for HIPDB revision?
• Which two organizations are cited as accreditation bodies for Managed Care Organizations (MCOs)?
• What term describes criteria defined by the hospital's medical staff and governing board?
• Which accreditation requires all verifications to be dated?
• For written verification received by the organization, which accreditation uses the date on the letter or report, not the receipt date?
• Which accreditation defines PSV as 'verification of a practitioner's credentials based upon evidence obtained from the issuing source of the credential'?
• To whom must all credentials be submitted for a decision under NCQA?
• What does COPs stand for?
• Which statement best describes internal criteria?
• NPDB was established in what year and by whom?
• Which organization accredits ambulatory care facilities?
• Which statement defines PSV according to accreditation?
• Which accrediting organization defines PSV as obtained through a secure electronic communication, approved website, or by phone contact with the primary source?
• What term refers to agencies that maintain credential data identical to the primary source?
• Which term describes the course of conduct or action pursued in managing a matter?
• Which NPDB query source is described as a state-level licensing body?
• Which accreditation requires the governing body to define criteria for the initial credentialing and reappointment of physicians and dentists, without specifying which providers must be credentialed?
• Which accreditation defines credentialing as the process of obtaining, verifying, and assessing the qualifications of a health care practitioner who seeks to provide patient care services in or for a hospital?
• In PSV processes, who can designate another organization as its agent to provide credential verification information?
• What information is available from NPDB?
• Which accreditation defines secondary source as 'Verification of a practitioner's credentials based upon evidence obtained by means other than direct contact with the issuing source of the credentialed'?
• What is the primary purpose of Policies in an organization?
• What term describes the defined requirements for appointment to the medical staff or provider panel?
• Which accreditation offers a Phone PSV that verifies licensure, education, training, experience, competence, and peer references?
• Which organization definition of PSV states that the process must include measures to demonstrate there is no interference in the communication by an outside party?
• Which accreditation explicitly uses criteria named "Quality of Care, Service, and business need of organization" for evaluating organizations?
• Which statement best describes the relationship between credentialing and regulatory compliance?
• Which term describes membership qualifications defined by the hospital's medical staff and governing board (or MCO board), including factors such as board certification and geographic distance?
• Who uses Policy and Procedures?
• Which organization defines Secondary Source as verification obtained from an acceptable agency that performs PSV?
• Which federal designation is listed as a NPDB query source that involves law enforcement?
• For internet and electronic verification NCQA uses what date in the credentialing file?
• Which statement best describes the role of external criteria?
• What is the definition of Secondary Source in credential verification as provided?
• The accreditation in which the governing body defines criteria for initial and reappointment of physicians and dentists without specifying which providers need to be credentialed is which?
• Which accreditation requires the governing body to define appointment criteria for the medical staff or provider panel?
• The term Policy and Procedures describes the course of conduct or action pursued in certain circumstances and is often used to address internal matters subject to frequent change. Which term is this describing?
• Which entity is primarily responsible for performing Primary Source Verification in credentialing?
• What does HIPDB stand for?
• Which statement best differentiates external criteria from internal criteria?
• Which organization is described as credentialing all licensed practitioners (physicians and non-physicians)?
• Which accreditation is specifically linked to ambulatory care facilities?
• Which accreditation is described as requiring all practitioners listed in the directory to be credentialed?
• To which accrediting body does PSV definition require verification via secure electronic communication or by phone contact with the primary source?
• When a PSV designates another organization as it's agent what is this called?
• What is the term called when a PSV designates another organization as its agent?
• Which are the five elements of COPs criteria for appointment?
• Which organization is listed among hospital accreditation bodies?
• Credentialing is described as required for all licensed practitioners (physicians and non-physicians) by which organization?
• Which organization defines PSV as verification based on evidence from the issuing source?
• Internal criteria are defined as
• Which organization defines PSV as including measures to demonstrate there is no interference in communication by outside parties?
• Which accreditation requires all participating providers and facilities that provide covered health care services to consumers to be credentialed, with all practitioners listed in the directory credentialed?
• Which accreditation uses a Phone PSV for verification of credentials including licensure and education?
• External criteria are defined as requirements set by forces outside the organization, such as
• Which areas are commonly included in credentialing and often required by regulatory agencies?
• A Licensed Independent Practitioner (LIP) is defined as which statement?
• Which organization is the primary hospital accreditation body mentioned?
• PSV stands for what in credential verification?
• Which accreditation does not require credentialing in certain settings, such as inpatient setting for organizational member only, pharmacy benefits management, or locum tenens unless the assignment lasts more than 90 days?
• Under which accreditation are hospitalists employed by a facility and not listed in the directory considered not credentialed?
• When determining compliance with time requirements for PSV, which accreditation counts backward from the date of the credentialing decision?
• Which term refers to credentialing criteria that originate from outside the hospital?
• What accreditation defines PSV: 'Verification of a practitioner's credentials based upon evidence obtained from the issuing source of the credential' ?
• What are the three primary reasons for credentialing?
• Which accrediting organization indicates requirements for PSV in Medical Staff Bylaws?
• Which entity is listed as a NPDB query source related to professional organizations?
• Which entity is listed as a possible NPDB query source at the federal level (general reference)?
• Which accreditation is associated with directory quality and service standards in credentialing?
• PSV stands for which of the following?
• Which accreditation defines credentialing as the process by which an organization reviews and evaluates the qualifications of licensed independent practitioners to provide services to its members?
• NCQA uses what date on PSV letter or report to determine compliance?
• Which accreditation requires credentialing of all practitioners listed in its directory?
• Medical Staff Membership requires bylaws to describe the qualifications required of a candidate in order for the medical staff to recommend appointment by the governing body; these qualifications are known as what?
• Which NPDB query source category includes agencies or contractors administering federal health care programs?
• Which accreditation uses Directory Criteria that emphasize quality of care, service, and the business need?
• Which organization defines credentialing as the process of reviewing and evaluating qualifications of licensed independent practitioners to provide services to its members?
• For internet and electronic verification NCQA uses what date in the credentialing file?
• Which two organizations are named together as accreditation bodies for Managed Care Organizations (MCOs)?
• What best defines core criteria in credentialing?
• In accreditation terminology, what term is used to describe the requirements for appointment to the medical staff or provider panel?
• Which body is most closely associated with credentialing standards in managed care organizations?
• What is the general term for the process of verifying a practitioner's education, training, and experience to grant hospital privileges?
• Which type of PSV verification is performed when the verification is obtained via a phone call?
• Which statement describes a Medicare-related benefit of accreditation?
• What document governs medical staff membership and appointment decisions?
• Which accreditation requires credentialing for all licensed practitioners (physicians and non-physicians)?
• In PSV processes, which body is responsible for reviewing verifications and rendering the credentialing decision within the time limits?
• Which accreditation has time limits on PSV and requires resubmission of verifications after expiry?
• For initial appointment, AMA profile is acceptable for licensure, education, specific training, and current competence. Which organization accepts this AMA profile as acceptable?
• What are agencies that have been determined to maintain specific items of credential information identical to the primary source?
• What term refers to agencies that maintain credential information identical to the primary source?
• Which accrediting body allows PSV to be conducted by mail, fax, telephone, or electronically?
• Which accreditation requires a directory with criteria including Quality of Care, Service, and business need?
• Which item is commonly considered internal criterion?
• Who can designate another organization as its agent in providing information to verify credentials?
• What is a primary purpose of COPs (Conditions of Participation) in accreditation?
• For initial appointment AMA profile is acceptable for licensure, education, specific training, and current competence.
• Which organization is associated with credentialing all licensed practitioners, including physicians and non-physicians?
• In hospital governance, which entity typically approves bylaws and accepts appointment decisions?
• Which organization sets time limits for PSV verifications?
• Why get accredited?
• Which organization states that PSV can be conducted by mail, fax, or electronically?
• Which accreditation must verify and submit all credentials to a Credentialing Committee or Medical Director for a decision within time limits?
• Which accreditation uses phone primary source verification for all information including licensure, education, training, experience, competence, and peer references?
• Which elements must be documented for PSV verification?
• Which entity is listed as a potential NPDB query source at the hospital/peer review level?
• Which accreditation does not require credentialing for physicians who are hospital employees and are not listed in the accreditation directory?
• Which accreditation is commonly abbreviated as AAAHC?
• Which practice helps ensure traceability of a PSV record?
• Which of the following combinations is listed as hospital accreditation bodies?
• PSV stands for which of the following?
• What must be documented for PSV?
• NPDB was established under which act?
• Which accreditation does not require credentialing in these settings: inpatient setting for organizational members only, pharmacy benefits management, or locum tenens unless over 90 days?
• Which accreditation's medical staff bylaws or credentials manual indicate PSV requirements?
• For written verification received by the organization, which accreditation uses the date on the letter or report, not the receipt date?
• Which NPDB query source category includes state Medicaid fraud control units?
• What does PSV stand for?
• Which set represents the accreditation bodies listed for hospitals?
• Which of the following best describes the purpose of HIPDB?
• Which of the following is NOT reported to NPDB?
• Which of the following best illustrates external criteria in credentialing?
• Which organization defines PSV as the process requiring documentation to demonstrate that communications are free from outside party interference?
• Which term describes the process of obtaining, verifying, and assessing the qualifications of a health care practitioner who seeks to provide patient care in a hospital?
• Who uses Policy and Procedures?
• Which accreditation has time limits on PSV and requires resubmission of verifications after expiry?
• Is a self query allowed for NPDB?
• Which term is defined as 'Verification of a practitioner\'s credentials based upon evidence obtained by means other than direct contact with the issuing source'?
• Which of the following is included in COP's criteria for appointment to the medical staff?
• Credentialing and privileging processes aim to protect patient safety by verifying practitioners' qualifications. Which option best states this purpose?
• PSV can be done by mail, fax, telephone, or electronically. Which accrediting organization recognizes this method?
• Which term refers to credentialing criteria defined by the hospital's own medical staff and governing board?
• Which accreditation uses directory criteria that include quality of care, service, and the business need of the organization?
• Which accreditation must verify and submit all credentials to the Credentialing Committee or Medical Director for a decision within the specified time limits?
• NCQA uses what date on PSV letter or report to determine compliance?
• Which organization is not listed as a hospital accreditation body in the material?
• Which organization is commonly cited as a hospital accreditation body along with DNV and HFAP?
• Qualifications for Membership may include
• Medicare may enter into an agreement with a state to survey hospitals accredited by which act?
• Which accreditation requires that all practitioners listed in the directory be credentialed?
• What is the reason for CoP's?
• Which accreditation requires all verifications to be dated?
• Which organization defines Secondary Source as verification is documented by obtaining a report from an acceptable agency that performs PSV?
• Which entities report to NPDB?
• For managed care organizations, which pair is named as accrediting bodies?
• Who sets time limits for PSV verifications?
• Which accrediting body is commonly recognized for hospital credentialing and privileging standards?
• Designated Equivalent Sources are described as?
• Which organization defines PSV as 'Verification of a practitioner\'s credentials based upon evidence obtained from the issuing source of the credential'?
• In credentialing, which organization's definition emphasizes reviewing and evaluating qualifications of licensed independent practitioners to provide services to its members?
• Which document includes detailed requirements for specific clinical processes and may include rules of each clinical department?
• Which organization type is explicitly listed as a NPDB query recipient that focuses on evaluating care quality outside direct practice?
• Which accreditation classifies physicians who are employees of a facility as hospitalists and who are not listed in the directory?
• When determining compliance with time requirements, which accreditation counts backward from the date of the credentialing decision?
• What is the most accurate description of a Licensed Independent Practitioner (LIP) in credentialing terms?
• Which accreditation is focused on ambulatory care facilities and carries the acronym AAAHC?
• Who may the Medical staff delegate authority for changing the Rules & Regulations?
• In what year was HIPDB revised?
• For credentialing reappointment, which organization lists PSV of licensure and current competence as primary qualifications?
• At reappointment what accreditation requires qualifications to include PSV of licensure and current competence.
• Which of the following is explicitly listed as a plaintiff-related NPDB query recipient?
• In credentialing terms, which term designates any individual permitted by law and by the hospital to provide patient care services without direction or supervision?
• Which statement best describes the handling of PSV verifications within time limits according to NCQA?
• Which criterion is part of core criteria for appointment to medical staff?
• What document outlines the qualifications required for appointment to the medical staff?
• Which accreditation defines PSV as verification based on evidence from the issuing source?
• Which is NOT one of the COPs five criteria?
• Which of the following is a valid method to obtain PSV according to the accreditation definitions?
• Which set of criteria is associated with URAC and includes the phrase Quality of Care, Service, and business need of organization?