CERTIFIED PROVIDER
CREDENTIALING
SPECIALIST CPCS
PRACTICE EXAM
COMPLETE
Question 1: A hospital's medical sta� bylaws con�ict with a newly e�ective state scope-of-practice law. Which authority controls the maximum legal scope?
Choices:
1) A committee chair's informal custom 2) Applicable state law 3) The older bylaws regardless of law 4) The practitioner's preference
Correct Answer: Applicable state law
Explanation: Medical sta� governance documents must comply with law. The organization should update its bylaws or policies rather than grant privileges beyond the lawful scope.Page 1
Question 2: A Medical Executive Committee makes a �nal recommendation that is adverse or includes limitations. Is the applicant eligible for expedited governing body approval under Joint Commission standards?
Choices:
1) Yes, if the practitioner has practiced at the hospital before 2) Yes, if the applicant is board certi�ed 3) Yes, expedited approval is required whenever a recommendation is adverse 4) No, an adverse or limited �nal MEC recommendation makes the applicant ineligible for expedited approval Correct Answer: No, an adverse or limited �nal MEC recommendation makes the applicant ineligible for expedited approval Explanation: The expedited process is designed for �les meeting de�ned clean criteria. A �nal MEC recommendation that is adverse or includes limitations makes the applicant ineligible for that process.Question 3: A health plan credentialing committee is reviewing an applicant with veri�ed credentials and a pending state board investigation but no �nal action.What is the best approach?
Choices:
1) Evaluate the available information under policy and applicable standards without treating a pending matter as either automatically harmless or automatically disqualifying 2) Ignore the investigation until a �nal sanction exists 3) Ask the state board to close the case for credentialing purposes 4) Automatically deny every pending investigation Correct Answer: Evaluate the available information under policy and applicable standards without treating a pending matter as either automatically harmless or automatically disqualifying Page 2
Explanation: Credentialing decisions should be based on veri�ed facts, organizational criteria, and fair process. Pending matters may require follow-up and careful evaluation rather than automatic conclusions.Question 4: Why is the date of a primary source veri�cation important?
Choices:
1) It replaces the expiration date of the credential 2) It determines the practitioner's salary 3) It is only needed for billing enrollment 4) It shows the currency of information relied on for the credentialing decision Correct Answer: It shows the currency of information relied on for the credentialing decision Explanation: Credentialing decisions must rely on information that is su�ciently current under applicable standards. The veri�cation date establishes when the source was checked.
Question 5: Which statement best distinguishes credentialing from privileging?
Choices:
1) Credentialing evaluates quali�cations; privileging authorizes speci�c clinical activities based on de�ned criteria 2) Credentialing is only for physicians; privileging is only for nurses 3) Credentialing determines pay rates; privileging veri�es addresses 4) Credentialing and privileging are identical terms Correct Answer: Credentialing evaluates quali�cations; privileging authorizes speci�c clinical activities based on de�ned criteria Page 3