CPCS UPDATED ACTUAL LATEST QUESTIONS AND
ANSWERS SURE A+
✔✔NPDB information available: - ✔✔Medical malpractice payments
Adverse licensure action
Dismissal or closure of proceedings
Adverse clinical privileging actions
Adverse professional society membership
Negative action or finding by State licensing or certification authority
Peer review negative findings
Adverse actions against DEA certification
Medicare Exclusion
✔✔Education & Residency/post-grad Verification Sources - ✔✔AMA, AOA,
ECFMG - foreign medical school
✔✔AMA - ✔✔American Medical Association
PSV education, state licensure, current/prior medical training, DEA status, Sanctions
(Medicaid/Medicare), Board by AMBS
Also has database for PAs
✔✔NPDB - ✔✔Professional liability actions resulting in final judgments
Sanctions from state licensing boards and Medicare/Medicaid
Adverse licensing action, against DEA cert
Medical malpractice payments
Hospitals report when privileges limited or revoked
✔✔Disaster Privileges - TJC - ✔✔Granted to volunteer LIPs
Volunteer must present govnt issues photo ID and one other document (picture hospital
ID card, PSV of license, current licesnse to practice, identification by hospital
employee...)
PSV must begin as soon as disaster starts and within 72 hours
✔✔Disaster Privileges - HFAP - ✔✔Temporary privileges allowed in disaster
Primary source ID - documented phone call acceptable
Use volunteers within scope of license
✔✔CDS - ✔✔Controlled Dangerous Substances (CDS)
✔✔NTIS - ✔✔National Technical Information Services
Maintains CSA Registration Database
✔✔CSA Database - ✔✔Controlled Substances Act
DEA authorizes this database as proof fo DEA registration
,✔✔DEA or CDS cert PSV - ✔✔URAC - copy of certificate or certificate number
NCQA - copy of cert,visual inspection documented, AMA/AOA Physician Masterfile, etc
✔✔When is DEA monitored - ✔✔before recommending initial privileges, reappointment,
expiration, and continually
✔✔DEA/CDS timeframe - NCQA - ✔✔must be current at time of action/transmittal
✔✔DEA/CDS timeframe - URAC - ✔✔6 months
✔✔Education PSV - ✔✔AMA, AOA
ECFMG - foreign medical school
AAPA - PAs
URAC - state licensing board if confirmed that State board verifies credentials
NCQA - sealed transcript with documentation of organizaiton opening
✔✔Education is not specifically verified when - ✔✔NCQA - higher credentials
(residency, or board certified) fellowship doesn't count
✔✔FCVS - ✔✔Federation Credentials Verification Service = Federation of State
Medical Board
✔✔Initial appointment profile required for - ✔✔HFAP
✔✔Approval process - ✔✔Complete application --> Department Chair (hospital) or
Medical Director (MCO) recommendation --> Credentials Committee (optional for
hospitals) --> MEC --> board
✔✔Credentialing committee required for - ✔✔NCQA - peer process
At minimum cred committee reviews practitioners who do not meet criteria
✔✔NCQA P&P for Follow-Up - ✔✔Providers have right to review credentialing
information obtained during process
Do not have right to review peer references/recommendations
Written notification required if credentialing info varies from what practitioner put on
application
Timeframe for changes to be made
✔✔Felony convictions - information required by? - ✔✔NCQA - application include
statement regarding felony convictions
HFAP - Application asks for criminal history
AAAHC - Applicant provides information on criminal conviction other than minor traffic
violation
, ✔✔Licensure - when verified? - ✔✔TJC, AAAHC, NCQA - specify ongoing monitoring
1) Initial appointment, 2) reappointment, renewal, 3) revision of clinical privileges, 4) at
time of expiration
✔✔Licensure - TJC timeframe/procedure - ✔✔Before recommending privileges, medical
staff evaluate challenges to or voluntary/involuntary relinquishment of license
✔✔Licensure actions - PSV - TJC - ✔✔FSMB
✔✔Licensure timeframe - NCQA - ✔✔180 days
120 CVO
✔✔Licensure states - NCQA - ✔✔verify states where practitioner provides care for
organization members
NOT every state practitioner holds or has ever held licensure
Sanctions should be looked at for every state generally (but check P&P)
✔✔Licensure states - URAC - ✔✔All states/jurisdictions that practitioner has provided
care
✔✔Staes in general - licensure - ✔✔Up to facility or MCO whether or not to cehck
licensure in every state applicant is or was ever licensed
✔✔Licensure (general) PSV - NCQA - ✔✔Directly with state licensing agency
Website from appropriate State licensing agency
✔✔Licensure sanctions timeframe - NCQA & URAC - ✔✔Most recent 5 year period
available in each state physician worked (NCQA), history of sanctions (URAC)
✔✔Licensure sanctions PSV - NCQA - ✔✔NPDB Continuous Query
FSMB
State agencies
HIPDB for non-physicians
Chiropractors - CIN-BAD
Oral Surgeon - NPDB, State Board Dental Examiners
Podiatrists - Federation of Podiatric Medical Boards, NPDB
✔✔Attestation NCQA - ✔✔initial & recred loss of licensure between license granted
✔✔Telemedicine licensure requirement - HFAP - ✔✔Licensed in state patient is located
and where telemedicine provider is located
✔✔Licensure sanctions PSV - HFAP - ✔✔state licensing agency
NPDB
ANSWERS SURE A+
✔✔NPDB information available: - ✔✔Medical malpractice payments
Adverse licensure action
Dismissal or closure of proceedings
Adverse clinical privileging actions
Adverse professional society membership
Negative action or finding by State licensing or certification authority
Peer review negative findings
Adverse actions against DEA certification
Medicare Exclusion
✔✔Education & Residency/post-grad Verification Sources - ✔✔AMA, AOA,
ECFMG - foreign medical school
✔✔AMA - ✔✔American Medical Association
PSV education, state licensure, current/prior medical training, DEA status, Sanctions
(Medicaid/Medicare), Board by AMBS
Also has database for PAs
✔✔NPDB - ✔✔Professional liability actions resulting in final judgments
Sanctions from state licensing boards and Medicare/Medicaid
Adverse licensing action, against DEA cert
Medical malpractice payments
Hospitals report when privileges limited or revoked
✔✔Disaster Privileges - TJC - ✔✔Granted to volunteer LIPs
Volunteer must present govnt issues photo ID and one other document (picture hospital
ID card, PSV of license, current licesnse to practice, identification by hospital
employee...)
PSV must begin as soon as disaster starts and within 72 hours
✔✔Disaster Privileges - HFAP - ✔✔Temporary privileges allowed in disaster
Primary source ID - documented phone call acceptable
Use volunteers within scope of license
✔✔CDS - ✔✔Controlled Dangerous Substances (CDS)
✔✔NTIS - ✔✔National Technical Information Services
Maintains CSA Registration Database
✔✔CSA Database - ✔✔Controlled Substances Act
DEA authorizes this database as proof fo DEA registration
,✔✔DEA or CDS cert PSV - ✔✔URAC - copy of certificate or certificate number
NCQA - copy of cert,visual inspection documented, AMA/AOA Physician Masterfile, etc
✔✔When is DEA monitored - ✔✔before recommending initial privileges, reappointment,
expiration, and continually
✔✔DEA/CDS timeframe - NCQA - ✔✔must be current at time of action/transmittal
✔✔DEA/CDS timeframe - URAC - ✔✔6 months
✔✔Education PSV - ✔✔AMA, AOA
ECFMG - foreign medical school
AAPA - PAs
URAC - state licensing board if confirmed that State board verifies credentials
NCQA - sealed transcript with documentation of organizaiton opening
✔✔Education is not specifically verified when - ✔✔NCQA - higher credentials
(residency, or board certified) fellowship doesn't count
✔✔FCVS - ✔✔Federation Credentials Verification Service = Federation of State
Medical Board
✔✔Initial appointment profile required for - ✔✔HFAP
✔✔Approval process - ✔✔Complete application --> Department Chair (hospital) or
Medical Director (MCO) recommendation --> Credentials Committee (optional for
hospitals) --> MEC --> board
✔✔Credentialing committee required for - ✔✔NCQA - peer process
At minimum cred committee reviews practitioners who do not meet criteria
✔✔NCQA P&P for Follow-Up - ✔✔Providers have right to review credentialing
information obtained during process
Do not have right to review peer references/recommendations
Written notification required if credentialing info varies from what practitioner put on
application
Timeframe for changes to be made
✔✔Felony convictions - information required by? - ✔✔NCQA - application include
statement regarding felony convictions
HFAP - Application asks for criminal history
AAAHC - Applicant provides information on criminal conviction other than minor traffic
violation
, ✔✔Licensure - when verified? - ✔✔TJC, AAAHC, NCQA - specify ongoing monitoring
1) Initial appointment, 2) reappointment, renewal, 3) revision of clinical privileges, 4) at
time of expiration
✔✔Licensure - TJC timeframe/procedure - ✔✔Before recommending privileges, medical
staff evaluate challenges to or voluntary/involuntary relinquishment of license
✔✔Licensure actions - PSV - TJC - ✔✔FSMB
✔✔Licensure timeframe - NCQA - ✔✔180 days
120 CVO
✔✔Licensure states - NCQA - ✔✔verify states where practitioner provides care for
organization members
NOT every state practitioner holds or has ever held licensure
Sanctions should be looked at for every state generally (but check P&P)
✔✔Licensure states - URAC - ✔✔All states/jurisdictions that practitioner has provided
care
✔✔Staes in general - licensure - ✔✔Up to facility or MCO whether or not to cehck
licensure in every state applicant is or was ever licensed
✔✔Licensure (general) PSV - NCQA - ✔✔Directly with state licensing agency
Website from appropriate State licensing agency
✔✔Licensure sanctions timeframe - NCQA & URAC - ✔✔Most recent 5 year period
available in each state physician worked (NCQA), history of sanctions (URAC)
✔✔Licensure sanctions PSV - NCQA - ✔✔NPDB Continuous Query
FSMB
State agencies
HIPDB for non-physicians
Chiropractors - CIN-BAD
Oral Surgeon - NPDB, State Board Dental Examiners
Podiatrists - Federation of Podiatric Medical Boards, NPDB
✔✔Attestation NCQA - ✔✔initial & recred loss of licensure between license granted
✔✔Telemedicine licensure requirement - HFAP - ✔✔Licensed in state patient is located
and where telemedicine provider is located
✔✔Licensure sanctions PSV - HFAP - ✔✔state licensing agency
NPDB
