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CPCS Practice Exam with complete solutions 2024_2025
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CPCS Practice Exam with complete solutions 2024_2025
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CPCS Practice Exam with completesolutions 2024/2025
Why is it important to check that the practitioner is not currently excluded,
suspended, debarred, or ineligible to participate in Federal health care programs?
- ANSWER-a. A facility could lose its accreditation if it does not do so
b. It is required by Medicare Conditions of Participation
c. The facility won't get paid for treating patients unless service is provided by an
authorized provider.
Which of the following credentials must be tracked on an ongoing basis? -
ANSWER-a. Post graduate education completed
b. Closed medical malpractice claims
c. Licensure.
According to NCQA standards, an organization that discovers sanction
information, complaints, or adverse events regarding a practitioner must take
what action? - ANSWER-a. Determine if there is evidence of poor quality that
could affect the health and safety of its members.
b. Immediately take action to remove the provider from its panel
c. Notify the practitioner that he/she is under investigation and initiate the hearing
process
What is the name of the entity that was established through the Health Care
Quality Improvement Act of 1986 to restrict the ability of incompetent
practitioners to move from state to state without disclosure or discovery of
previous medical malpractice payment and adverse action history? - ANSWER-a.
Emergency Medical Treatment and Active Labor Act
b. The National Practitioner Data Bank.
c. The Patient Safety and Quality Improvement Act
,When developing clinical privileging criteria, which of the following is important
to evaluate? - ANSWER-a. How many providers are in that specialty
b. Established standards of practice, such as specialty board recommendations.
c. Whether or not the quality department can support the FPPE process
What is the main reason for periodically assessing appropriateness of clinical
privileges of each specialty? - ANSWER-a. It is required by accreditation
standards
b. It is required by the Medicare Conditions of Participation
c. To protect patient safety by ensuring current competency, relevance to the
facility, and accepted standards of care.
Which of the following specialists is most likely to perform a PTCA? - ANSWER-a.
OB/GYN
b. Urologist
c. Interventional Cardiologist.
(PTCA = Percutaneous transluminal coronary angioplasty aka stent placement)
The Joint Commission hospital standards require that clinical privileges are
hospital specific and... - ANSWER-a. Based on the individual's demonstrated
current competence and the procedures the hospital can support.
b. Based on board certification
c. Based on the privileges the individual is currently approved to perform at other
hospitals
Which of the following would be routinely performed by a cardiologist? -
ANSWER-a. Hysterectomy
b. Transesophageal Echocardiography.
c. Urethral dilation
Which NCQA-required committee makes recommendations regarding
credentialing decisions? - ANSWER-a. Medical Executive Committee
b. Quality Care Committee
c. Credentialing Committee.
HFAP standards require which three medical staff committees to be delineated in
the medical staff structure? - ANSWER-a. Medical Executive Committee.
b. Utilization of Osteopathic Methods & Concepts Committee. (required for
hospitals with ten or more DOs who admit patients and provide direct patient
care)
c. Utilization Review Committee.
, d. Credentials Committee
e. Investigational Review Board
How often does NCQA require that delegation reports be evaluated by the health
plan? - ANSWER-a. Monthly
b. Quarterly
c. Semi-Annually.
Peer references should be obtained from: - ANSWER-a. Practitioners who have
referred patients to the provider
b. Former hospital administrators
c. Practitioners in the same professional discipline as the applicant.
NCQA recognizes which of the following as the final approval of an applicant who
does not meet criteria for a clean file? - ANSWER-a. Medical Director
b. Credentialing Committee.
c. Board of Directors
If a medical staff member has privileges and/or medical staff appointment
revoked, he/she must be: - ANSWER-a. Granted temporary privileges
b. Provided due process.
c. Reported immediately to the National Practitioner Data Bank
Access to credentials files should be: - ANSWER-a. Described fully in an access
policy.
b. Available to the organization's patients and potential patients
c. Available to any physician on the staff
Which of the following bodies approves clinical privileges? - ANSWER-a.
Credentials Committee
b. Medical Executive Committee
c. Governing Body or Board.
What primary source verification is required by NCQA prior to provisional
credentialing? - ANSWER-a. Licensure and 5-year malpractice history or NPDB.
b. Education and Training
c. Ability to perform privileges requested
According to The Joint Commission standards, initial appointment to the medical
staff are made for a period of: - ANSWER-a. One year
b. Three years
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