CPCS Credentialing and Privileging Practice Test

These questions are part of the practice quiz. Start practicing

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