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NEW CPCS EXAM QUESTIONS AND VERIFIED ANSWERS
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NEW CPCS EXAM QUESTIONS AND VERIFIED ANSWERS...
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NEW 2025-2026 CPCS EXAM QUESTIONS ANDVERIFIED ANSWERS
Q - The _____ defines credentialing as "the process of obtaining, verifying, and
assessing the qualifications of a health care practitioner who seeks to provide
patient care services in or for a hospital. - ANSWER A - The Joint
Commission
Q- The _____ defines credentialing as a process by which an organization
reviews and evaluates the qualifications of licensed independent practitioners to
provide services to its members. - ANSWER A - NCQA
Q - What are the reasons for credentialing? - ANSWER A - Patient Safety /
Risk management concerns / Accrediting and Regulatory Agency Requirements
Q - Why become accredited? - ANSWER A -Accredited organizations are
granted "deemed status" meaning they meet the Medicare and Medicaid (CMS)
requirements for participation in Medicare, Medicaid, and other federal
healthcare programs (CoPs) and are, therefore, exempt from routine state
surveys to assess compliance.
Q - What are the accrediting bodies for hospital settings? - ANSWER A - TJC
/ HFAP / DNV-GL
Q - What does DNV-GL stand for? - ANSWER A - Det Norske Veritas -
Germanisher Lloyd
Q - What are the main accrediting bodies for health plans? - ANSWER A -
NCQA / URAC
,Q - What is the appropriate accrediting organization for ambulatory care
facilities? i.e. medical offices/surgical centers? - ANSWER A - AAAHC
Q - Which one of the following list of accrediting organizations has deemed
status? - ANSWER A - TJC / HFAP / DNV / URAC - only for Medicare
Advantage / AAAHC
Q - What defines the roles & responsibilities & govern the behavior of the body
& its members? - ANSWER A - Bylaws, Rules & Regs, and Policies of the
Medical Staff
Q - What provides guidelines necessary to ensure compliance with legal
requirements & accreditation and regulatory agencies? - ANSWER A - Bylaws
Q - These outline what medical staff appointees can and cannot do. - ANSWER
A - Rules & Regs
Q - These define the way of behaviour or line of action followed or adopted on
a specific occasion or in certain circumstances. Management of an affair or
matter. - ANSWER A - Policies & Procedures
Q - Where would the following requirements be found: emergency room
coverage for unassigned patients, membership dues, and completion of medical
records? - ANSWER A - Rules & Regs.
Q - What are these usually used for? These are usually used to address internal
issues that may change more often. Such as: disruptive behavior, sexual
harassment, document confidentiality - ANSWER A - Policies & Procedures
, Q - What is the process generally followed when there are any changes to the
bylaws? - ANSWER A - 1) Meeting of Bylaws Committee; 2) Input from Med
Staff, admin, atty, etc.; 3) MEC; 4) Notice to Med Staff; 5) Vote by Med Staff;
6) Approval by the Gov. Body; 7) Notification of changes to Med Staff.
Q - To whom can the Medical Staff delegate this authority for changing the
Rules & Regs? - ANSWER A - The MEC
Q - What is "MCO" an abbreviation of? - ANSWER A - Managed Care
Organization
Q - Must MCO's use Bylaws and Rules & Regs. as would the medical staff of a
hospital? - ANSWER A - No. The MCO's use Policies & Procedures to outline
the required functions.
Q - In this appointment to the entity, practitioners are being appointed to a
provider panel and participating with the health plan. - ANSWER A - MCO
Q - Any Individual permitted by law and by the hospital to provide patient care
services without direct supervision, within the scope of his or her license, and in
accordance with individually granted clinical privileges. - ANSWER A -
Licensed Independent Practitioners - LIP
Q - Which organization credentials all practitioners-physicians and non-
physicians-who are licensed, certified or registered by the state to practice
independently and provide care to its members (or patients) under its medical
benefits? - ANSWER A - NCQA
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