CPCS Credentialing and Privileging Practice Test

These questions are part of the practice quiz. Start practicing

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