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CERTIFIED PROVIDER CREDENTIALING SPECIALIST CPCS STUDY GUIDE EXAM
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CERTIFIED PROVIDER CREDENTIALING SPECIALISTCPCS STUDY GUIDE EXAM
Specialist in Certified Provider Credentialing - ANSWER Typically, a
healthcare organization—such as hospitals (health systems), health plans,
ambulatory care facilities, group practices, and credentialing verification
organizations—hires or contracts the Certified Provider Credentialing Specialist
(CPCS).
The TJC's initial appointment, clinical privileges, and practitioners are covered
The structured medical staff structure requires all licensed independent
practitioners to have credentials and privileges.
Clinical privileges, initial appointments, and practitioners covered by the
NCQA ANSWER All practitioners who care for the organization's members
must adhere to the specified credentialing policies and processes of HPs and
MBHOs.
CMS-recommended initial appointment, clinical privileges, and practitioners
covered ANSWER According to Staye Law, the governing authority chooses
which kind of practitioners can be appointed to the medical staff. MDs and DOs
must make up the medical personnel, at the very least.
According to the TJC, medical education verification calls for confirmation
from the medical school or an approved PSV.
The AMA, the AOA, and the ECFMG responded that TJC accepted PSV for
medical education.
According to the NCQA, HP/CVO must have completed the top three levels of
education and training in order to verify medical education.
According to NCQA, there are three degrees of education and training: board
certification, residency, and medical or professional school graduation.
Medical education verification in accordance with CMS-ANSWER The
medical personnel needs a way to look at proof of professional training.
, Postgraduate training verification in accordance with TJC-ANSWER needs
confirmation from the original source or approved substitutes.
ANSWER AMA and AOA PSV was accepted by TJC for postgraduate training.
Postgraduate training verification in accordance with NCQA-ANSWER
reached the highest of the three educational and training levels. Board
certification is sufficient if it exists.
Postgraduate training verification in accordance with CMS-ANSWER The
medical personnel needs a way to review training records and documented
experiences.
Board certification verification in accordance with TJC-ANSWER If
certification is required by the medical staff bylaws, policies, or rules and
regulations, the TJC requirements do not expressly call for board certification
verification. Nonetheless, some kind of verification of board certification is
expected.
Board certification verification in accordance with NCQA-ANSWER Board
certification is not required by NCQA. Verification can be received directly
from the specialized board, AMA, or AOA if the person is board certified.
Doctor Verification with ABMS Certification: ANSWER The NCQA does not
accept it as a source for board certification verification. The website is solely for
customer reference.
Board certification verification in accordance with CMS-ANSWER Board
certification is not particularly included in CMS requirements. The medical staff
must take into account all aspects of training and professional education when
making recommendations; they cannot rely their decisions only on board
certification.
ANSWER: Confirmation of current licensure in accordance with TJC
Verification from the State licensing board where the practitioner is asking
privileges is a primary source.
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