CPCS/CPMSM EXAM STUDY GUIDE
2026 COMPLETE QUESTIONS WITH
CORRECT DETAILED ANSWERS ||
100% GUARANTEED PASS
<RECENT VERSION>
1. Applicant completes an application that includes, reasons for inability to
perform, las of present illegal drug use, loss of license or felony convictions.
Loss or limitation of privileges or disciplinary actions. Current malpractice
insurance coverage, current signed attestation confirming the correctness and
completeness of the application. If an application from an external entity is
used it must include the questions and attestations as identified above.
Signature stamps are not acceptable unless the practitioner is physically
impaired and the disability is documented in the practitioners file. -
ANSWER ✔ NCQA Health Plan/CVO
2. Which type of agenda is used on a meeting agenda to group together non-
controversial business and reports that can be approved under one motion
instead of individually approving each item? - ANSWER ✔ Consent Agenda
3. According to NCQA under what circumstance would a Locum Tenens
practitioner be exempt from credentialing? - ANSWER ✔ Covering
Practitioner
,4. According to URAC, when developing a quality auditing process, prudent
practice would be to audit what percentage of completed credentialing files?
- ANSWER ✔
5. According to URAC, a complete credentials file should be reviewed by
which professionals? - ANSWER ✔
6. According to NCQA, what must be included in the organization's right to
appeal policies? - ANSWER ✔ written notification when a professional
review action has been brought against a practitioner
reasons for the action
summary of the appeal rights and process
ability to request a hearing and the specific time period for submitting the
request
allowing for at least 30 calendar days after the notification for practitioners
to request a hearing
allowing representation by an attorney or another person
appointment of a hearing officer or a panel of individuals to review the
appeal
and written notification of the appeal decision that contains specific reasons
for the decision.
7. Which Accrediting body requires an attestation to the practitioners identity?
- ANSWER ✔ The Joint Commission
,8. According to HFAP, how often must a reappraisal of membership and
privileges occur? - ANSWER ✔ Every 24 months
9. Which Accrediting Agency requires all practitioners with clinical privileges
to participate in continuing education? - ANSWER ✔ DNV
10.Are limitations of the clinical privileges of a psychiatrist for more than 30
days reportable to the NPDB? - ANSWER ✔ Yes
11.According to the Joint Commission, who may amend the medical staff
bylaws? - ANSWER ✔ Governing Body
12.Failure to meet the established qualifications and criteria for appointment
should be reported to whom? - ANSWER ✔ The applicant
13.NCQA requires the MCO to obtain a minimum of ???? years of work
history? - ANSWER ✔ 5 years
14.According to NCQA what policy must an organization have in place to
obtain approval to enter into a delegated agreement? - ANSWER ✔
Credentialing policies
15.How often does the OIG report to the NPDB? - ANSWER ✔ Monthly
, 16.Hospitals must query the NPDB when: - ANSWER ✔ Initial appt, granting
of privileges, every two years
17.NCQA requires verifications must be less than how many days old? -
ANSWER ✔ 180 days
18.What is the verification time limit on malpractice history according to the
NCQA? - ANSWER ✔ 180 days
19.Time limited credential must be verified by the CVO within how many days
prior to submission to the client? - ANSWER ✔ 120 days
20.According to AAAHC, for initial appointments, in addition to licensure and
education, what verification is required? - ANSWER ✔ Experience and
hospital affiliation
21.What accreditation body states "the NPDB is an acceptable source for
sanctions or limitations on licensure, Medicaid/Medicare sanctions and
malpractice history? - ANSWER ✔ NCQA
22.Who is required to query the NPDB? - ANSWER ✔ Hospitals
23.Is disciplinary action taken against the license of a dentist reportable to the
NPDB? - ANSWER ✔ Yes
2026 COMPLETE QUESTIONS WITH
CORRECT DETAILED ANSWERS ||
100% GUARANTEED PASS
<RECENT VERSION>
1. Applicant completes an application that includes, reasons for inability to
perform, las of present illegal drug use, loss of license or felony convictions.
Loss or limitation of privileges or disciplinary actions. Current malpractice
insurance coverage, current signed attestation confirming the correctness and
completeness of the application. If an application from an external entity is
used it must include the questions and attestations as identified above.
Signature stamps are not acceptable unless the practitioner is physically
impaired and the disability is documented in the practitioners file. -
ANSWER ✔ NCQA Health Plan/CVO
2. Which type of agenda is used on a meeting agenda to group together non-
controversial business and reports that can be approved under one motion
instead of individually approving each item? - ANSWER ✔ Consent Agenda
3. According to NCQA under what circumstance would a Locum Tenens
practitioner be exempt from credentialing? - ANSWER ✔ Covering
Practitioner
,4. According to URAC, when developing a quality auditing process, prudent
practice would be to audit what percentage of completed credentialing files?
- ANSWER ✔
5. According to URAC, a complete credentials file should be reviewed by
which professionals? - ANSWER ✔
6. According to NCQA, what must be included in the organization's right to
appeal policies? - ANSWER ✔ written notification when a professional
review action has been brought against a practitioner
reasons for the action
summary of the appeal rights and process
ability to request a hearing and the specific time period for submitting the
request
allowing for at least 30 calendar days after the notification for practitioners
to request a hearing
allowing representation by an attorney or another person
appointment of a hearing officer or a panel of individuals to review the
appeal
and written notification of the appeal decision that contains specific reasons
for the decision.
7. Which Accrediting body requires an attestation to the practitioners identity?
- ANSWER ✔ The Joint Commission
,8. According to HFAP, how often must a reappraisal of membership and
privileges occur? - ANSWER ✔ Every 24 months
9. Which Accrediting Agency requires all practitioners with clinical privileges
to participate in continuing education? - ANSWER ✔ DNV
10.Are limitations of the clinical privileges of a psychiatrist for more than 30
days reportable to the NPDB? - ANSWER ✔ Yes
11.According to the Joint Commission, who may amend the medical staff
bylaws? - ANSWER ✔ Governing Body
12.Failure to meet the established qualifications and criteria for appointment
should be reported to whom? - ANSWER ✔ The applicant
13.NCQA requires the MCO to obtain a minimum of ???? years of work
history? - ANSWER ✔ 5 years
14.According to NCQA what policy must an organization have in place to
obtain approval to enter into a delegated agreement? - ANSWER ✔
Credentialing policies
15.How often does the OIG report to the NPDB? - ANSWER ✔ Monthly
, 16.Hospitals must query the NPDB when: - ANSWER ✔ Initial appt, granting
of privileges, every two years
17.NCQA requires verifications must be less than how many days old? -
ANSWER ✔ 180 days
18.What is the verification time limit on malpractice history according to the
NCQA? - ANSWER ✔ 180 days
19.Time limited credential must be verified by the CVO within how many days
prior to submission to the client? - ANSWER ✔ 120 days
20.According to AAAHC, for initial appointments, in addition to licensure and
education, what verification is required? - ANSWER ✔ Experience and
hospital affiliation
21.What accreditation body states "the NPDB is an acceptable source for
sanctions or limitations on licensure, Medicaid/Medicare sanctions and
malpractice history? - ANSWER ✔ NCQA
22.Who is required to query the NPDB? - ANSWER ✔ Hospitals
23.Is disciplinary action taken against the license of a dentist reportable to the
NPDB? - ANSWER ✔ Yes
