CPCS EXAM BANK WITH 138
QUESTIONS AND CORRECT
ANSWERS RATED A+ 2026/2027
[NEWEST!!!]
According to the JC a fair hearing and appeals process as described in the medical
staff bylaws is available to whom?
Medical staff members and non-members holding clinical privileges
T/F Only the highest of training must be verified according to NCQA
True
According to the Joint Commission a peer recommendation should address what
six competencies?
Medical knowledge\nTechnical & clinical skill\nclinical judgment\ninterpersonal
skills\ncommunication skills\nprofessionalism
Telemedicine - according to JC what two options are available for credentialing a
the original site?
Full credentialing, use of the distant sites credentialing
According to JC what is included in the process of planning and implementing
privileges?
Develop & approve procedure list\nProcess the application\nEvaluate applicant
specific information\nSubmit recommendations to governing body for applicant
specific delineated privileges\nNotify the applicant, relevant personnel\nMonitor
the use of privileges
Are payments made by a physician in a malpractice claim reportable to the NPDB?
No
Who requires Peer References
JC, HFAP, AAAHC
,Who reappoints
JC, HFAP, NCQA, URAC
Who requires an attestation?
NCQA, URAC, AAAHC
Who requires education verification?
JC, HFAP, URAC, AAAHC
Who requires statement regarding felony convictions?
HFAP, NCQA, AAAHC
Attestation must state that the information submitted is complete & correct
NCQA, AAAHC
Attestation must state that the information submitted is complete & accurate
URAC
What two accreditors state: a hospital may not rely solely on board certification
when considering practitioner for medical staff membership?
HFAP, CMS
According to JC & HFAP name four approved sources PSV for Medical Education
Medical School, AMA, ECFMG, AOA
According to NCQA practitioners must be notified of credentialing decision within
how many days?
60 Days
The DHHS mails a copy of the NPDB report to the named provider. If the provider
wishes to dispute the reports accuracy, the provider has how many days to do so?
60 Days
According to URAQ, within how many days must the practitioner be notified of
credentialing decisions?
10 Days
,How many days does a practitioner have to dispute an NPDB report accuracy
60 Days
Which accrediting body requires five year verification of malpractice history
NCQA
What is commonly used source for verifying malpractice history
NPDB
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 the Joint Commission require evaluation of malpractice
history?
Back to Medical School
According to JC, what source may be used to verify malpractice history?
NPDB
Is an internet verification from a website not contracted by the primary source
that attest 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 personnnel?
Joint Commission - CMS
Who requires background checks?
HFAP (the only organization that requires)
Is a payment made by an insurance company reportable to the NPDB?
Yes
According to NCQA what providers are NOT required to be credentialed when
working in an independent relationship?
Locum Tenens\nHospital based practitioners (i.e., anesthesia, pathology,
radiology, etc.)
Is denial of a medical license application by a state medical board reportable to
the NPDB
Yes
Telemedicine - according to JC what two options are available for credentialing at
the originating site?
Full credentialing\nUse of the distant sites credentialing
QUESTIONS AND CORRECT
ANSWERS RATED A+ 2026/2027
[NEWEST!!!]
According to the JC a fair hearing and appeals process as described in the medical
staff bylaws is available to whom?
Medical staff members and non-members holding clinical privileges
T/F Only the highest of training must be verified according to NCQA
True
According to the Joint Commission a peer recommendation should address what
six competencies?
Medical knowledge\nTechnical & clinical skill\nclinical judgment\ninterpersonal
skills\ncommunication skills\nprofessionalism
Telemedicine - according to JC what two options are available for credentialing a
the original site?
Full credentialing, use of the distant sites credentialing
According to JC what is included in the process of planning and implementing
privileges?
Develop & approve procedure list\nProcess the application\nEvaluate applicant
specific information\nSubmit recommendations to governing body for applicant
specific delineated privileges\nNotify the applicant, relevant personnel\nMonitor
the use of privileges
Are payments made by a physician in a malpractice claim reportable to the NPDB?
No
Who requires Peer References
JC, HFAP, AAAHC
,Who reappoints
JC, HFAP, NCQA, URAC
Who requires an attestation?
NCQA, URAC, AAAHC
Who requires education verification?
JC, HFAP, URAC, AAAHC
Who requires statement regarding felony convictions?
HFAP, NCQA, AAAHC
Attestation must state that the information submitted is complete & correct
NCQA, AAAHC
Attestation must state that the information submitted is complete & accurate
URAC
What two accreditors state: a hospital may not rely solely on board certification
when considering practitioner for medical staff membership?
HFAP, CMS
According to JC & HFAP name four approved sources PSV for Medical Education
Medical School, AMA, ECFMG, AOA
According to NCQA practitioners must be notified of credentialing decision within
how many days?
60 Days
The DHHS mails a copy of the NPDB report to the named provider. If the provider
wishes to dispute the reports accuracy, the provider has how many days to do so?
60 Days
According to URAQ, within how many days must the practitioner be notified of
credentialing decisions?
10 Days
,How many days does a practitioner have to dispute an NPDB report accuracy
60 Days
Which accrediting body requires five year verification of malpractice history
NCQA
What is commonly used source for verifying malpractice history
NPDB
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 the Joint Commission require evaluation of malpractice
history?
Back to Medical School
According to JC, what source may be used to verify malpractice history?
NPDB
Is an internet verification from a website not contracted by the primary source
that attest 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 personnnel?
Joint Commission - CMS
Who requires background checks?
HFAP (the only organization that requires)
Is a payment made by an insurance company reportable to the NPDB?
Yes
According to NCQA what providers are NOT required to be credentialed when
working in an independent relationship?
Locum Tenens\nHospital based practitioners (i.e., anesthesia, pathology,
radiology, etc.)
Is denial of a medical license application by a state medical board reportable to
the NPDB
Yes
Telemedicine - according to JC what two options are available for credentialing at
the originating site?
Full credentialing\nUse of the distant sites credentialing
