CPCS - CERTIFIED PROVIDER

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CPCS - CERTIFIED PROVIDER

CREDENTIALING SPECIALIST UPDATED

ACTUAL EXAM WITH CORRECT SOLUTIONS.

Are limitations of the clinical privileges of a psychiatrist for more than 30 days reportable to the NPDB? - correct answer- Yes

According to TJC, who may amend the medical staff bylaws? - correct answer- Governing body/board.

Failure to meet the established qualifications and criteria for appointment should be reported to whom? - correct answer- The applicant

NCQA requires the MCO to obtain a minimum of how may years of work history? - correct answer- Five years

According to the NCQA what policy must an organization have in place to obtain approval to enter into a delegated agreement? - correct answer- Credentialing policies

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How often does the OIG report to the NPDB? - correct answer- Monthly

When must hospitals query the NPDB? - correct answer- Initial appointment, granting of privileges, every two years.

NCQA requires verifications must be less than how many days old? - correct answer- 180 days

What is the verification time limit on malpractice history according to the NCQA? - correct answer- 180 days

Time limited credential must be verified by the CVO with how may days prior to submission to the client? - correct answer- 120 days

According the AAAHC, for initial appointments, in addition to licensure and education, what verification is required? - correct answer- Experience and hospital affiliations.

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What accreditation body states "The NPDB is an acceptable source for sanctions or limitations on licensure, Medicaid/ Medicare sanctions and malpractice history? - correct answer- NCQA

Who is required to query the NPDB? - correct answer- Hospitals

Is disciplinary action taken against the license of a dentist reportable to the NPDB? - correct answer- 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? - correct answer-

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According to NCQA, verification of Medicare/Medicaid sanctions can be queried by any of what sources? - correct answer- 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? - correct answer- Annually

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