National Committee for Quality Assurance (NCQA) Practice Exam

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• Which statement best describes a required attestation content?
• Which statement best defines closed-loop referral management?
• The NPDB provides ongoing checks for sanctions across multiple health professions.
• How should NCQA submissions address privacy and data security?
• What is information blocking, and why does it matter for NCQA?
• What data sources are allowed for HEDIS reporting?
• Is NCQA verification of clinical privileges required?
• NCQA counts the three-year credentialing cycle in terms of which unit?
• In provisional credentialing, if there is no past malpractice history, which item can satisfy the requirement?
• What type of monitoring is required for Medicare/Medicaid sanctions under NCQA?
• Under NCQA standards, what status must non-physician practitioners have to provide care under the organization's medical benefits?
• What does NCQA say about peer recommendations in credentialing?
• Which of the following is NOT an approved source to verify sanctions or limitations on state licenses for physicians under NCQA credentialing?
• Which category is NOT exempt from credentialing according to NCQA?
• Is a notarized signature explicitly required by NCQA for credentialing?
• Which of the following represents the types of signatures NCQA allows?
• What is the maximum gap allowed in a provider's work history before clarification is required?
• Which item is a component of site standards for quality?
• How long is PSV board certification good for for CVO according to NCQA?
• Which of the following categories is not listed by NCQA as a credentialing category?
• Which item is not a permissible basis for credentialing decisions?
• Which item is included in NCQA's attestation list related to background information?
• For the application’s final approval, how long is the applicant's signature initially valid?
• Name two example HEDIS diabetes measures.
• Are practitioners required to be notified about recredentialing approvals?
• Which domain is most directly focused on coordinating care across providers and transitions?
• How long can a provider be provisionally credentialed for per NCQA?
• Which statement best describes measurement definitions in NCQA programs?
• NCQA recognizes residency programs that have been accredited by which bodies?
• Does the PSV 180/120 day time limitation apply to DEA/CDS?
• Which term is used to denote verification of board certification via primary sources before credentialing?
• Which action is explicitly listed as part of the intervention plan when a site fails to meet thresholds?
• Which document is an acceptable verification for NCQA credentialing?
• In HEDIS, what are the numerator and denominator?
• Under NCQA, which practitioners are included in the Behavioral Healthcare category?
• Which of the following best illustrates a Quality Improvement (QI) project documentation method?
• How long is PSV board certification good for for MCO according to NCQA?
• If there is a complaint about a provider, NCQA requires evaluation of which elements?
• What is the primary purpose of benchmarking in NCQA programs?
• FCVS stands for Federation Credentials Verification Service and is used for which residency programs?
• Which statement best describes the relationship between site standards and patient access?
• How are care transitions measured in NCQA/HEDIS?
• What is the interval for evaluating effectiveness of actions after addressing deficiencies?
• What sampling evidence is typically required to demonstrate patient access performance?
• What information must be stated for start and end dates in a provider's work history?
• If a CVO is NCQA-certified, what is the impact on the delegated entity's reporting requirement?
• Which statement best describes NCQA's malpractice coverage verification requirement during initial credentialing?
• Why must there be evidence of standard compliance for PCMH recognition?
• What evidence demonstrates 'Access and Continuity' in PCMH recognition?
• A patient care plan typically includes which elements?
• Which statement about start and end date documentation is true under NCQA policy?
• Under what condition does NCQA allow the use of signature stamps?
• Which of the following best describes the scope of the ongoing competency monitoring?
• What is NCQA's approach to ongoing competency?
• How many days does the organization have to update its directory after receiving new information from a practitioner?
• Which statement correctly describes the Plan-Do-Study-Act (PDSA) cycle?
• How is patient safety integrated into PCMH evaluation?
• Which type of evidence is typically needed for NCQA self-assessment?
• CAHPS data is used to measure which of the following?
• What is closed-loop referral management?
• How many years back must malpractice/professional liability history be checked for credentialing under NCQA?
• What is the verification timeline for licensure per NCQA CVO?
• How often must evidence of an evaluation of the history of complaints be maintained for all practitioners?
• What is a sampling plan, and how is it used in HEDIS?
• What is the primary purpose of NCQA accreditation and recognition programs?
• Which source is explicitly listed as an acceptable primary verification source for board certification under NCQA guidance?
• What does PSV stand for in credentialing?
• Which statement best describes the role of EHRs in PCMH?
• Must a provider complete the attestation before the organization conducts credentialing verifications and other queries?
• What is a care gap, and how is it closed in NCQA terms?
• Does NCQA use the term "Designated Equivalent Sources"?
• If a copy of an application from an external entity is used, what must be included per NCQA?
• CINBAD is used to verify sanctions for which profession?
• Which statement best describes NCQA's requirement for detecting and responding to quality issues?
• If the applicant's signature expires, what does NCQA require?
• What is the verification time limit for education according to NCQA?
• Why is sampling used in HEDIS data collection when full data capture is not feasible?
• How far back must sanctions or license limitations be verified in each state where care is provided?
• What does shared decision-making require?
• Which factor must not be used as a basis for credentialing decisions?
• How are enrollment gaps treated in HEDIS denominator calculations?
• NCQA recognizes residency programs accredited by which bodies?
• Who does NCQA consider the final decision maker for files?
• In HEDIS data collection, what does sampling mean?
• What best defines utilization management (UM) in NCQA standards?
• If using a CVO, how often must a delegated entity report to the organization?
• How often is CAHPS data typically collected for NCQA reporting?
• What are "measurement definitions" and why are they important?
• During an NCQA on-site review, which activities are typically performed to validate standards?
• What is included in "member outreach" within PCMH?
• What describes formal governance in NCQA accreditation?
• In care transitions measurement, what is tracked after a hospital admission or ED visit?
• Which of the following best describes how often a site visit is performed after a threshold is met?
• Under NCQA credentialing, in which scenario is malpractice/professional liability history not required?
• How is claims data reliability checked in NCQA submissions?
• Which practitioners need to be credentialed under NCQA guidelines?
• Why is provider directory accuracy important to NCQA?
• The NPDB continuous query is designed to provide what capability in credentialing?
• What is required for an agent who verifies credentials on behalf of an approved source?
• What is the purpose of risk adjustment in HEDIS measures?
• What is the function of a patient care plan in PCMH?
• To participate in a managed care plan, a provider must be accepted to the plans?
• Which action is described as part of the organization's interventions when an office does not meet site standards?
• NCQA credentialing policies apply to which groups of practitioners?
• What does data quality verification entail for NCQA submissions?
• Is NCQA privilege or payer focused?
• Which documentation is typically required for physician credentialing?
• What does 'top-box' mean in CAHPS scoring?
• What is the primary role of data privacy controls in NCQA data handling?
• Which of the following is NOT an approved source to verify sanctions or limitations on state licenses for non-physician behavioral health professionals?
• Who conducts the on-site assessment in NCQA programs?
• What is the minimum amount of work history that must be obtained for a provider's application or CV?
• Which of the following is an approved education verification source (general, not restricted to a single program)?
• Under NCQA requirements, board certification satisfies the credentialing threshold for which aspect?
• NPDB stands for which of the following?
• Which practice supports HIPAA-compliant NCQA submissions?
• During recredentialing, verification of board certification is required when there is no end date.
• CINBAD is used as an approved source for sanctions verification for which profession?
• Which of the following is NOT typically included in Team-Based Care under PCMH standards?
• What is a Quality Improvement (QI) project in NCQA terms?
• What are denominator exclusions in HEDIS measures?
• Which policy describes how the organization monitors practitioner site complaints?
• CINBAD stands for which database used in credentialing?
• Under NCQA credentialing policies, which practitioners must be covered?
• Which organization provides credentialing oversight across state medical boards and is commonly cited in credentialing?
• Which practice is essential for secure NCQA data submissions?
• What does CAHPS stand for and what does it measure?
• Which source is used for license verification in the context of multi-state providers?
• What is the primary purpose of the National Practitioner Data Bank in credentialing?
• In HEDIS reporting, what distinguishes structure, process, and outcome measures?
• Which source is listed as an approved option to verify education for closed residency programs?
• Annually, what must an organization verify and obtain written confirmation of, per NCQA?
• Who can the organization designate approval authority of clean files to?
• What is the typical use of CAHPS data in NCQA reporting?
• Which of the following is included in NCQA's credentialing exemptions policy?
• In states where providers hold multiple licenses, where must you verify?
• Which of the following is an example of a denominator exclusion?
• Within how many calendar days must a practitioner be notified of a credentialing or recredentialing denial decision?
• Why is data quality verification important for NCQA submissions?
• Which statement best describes the purpose of measurement definitions for NCQA PCMH recognition?
• If state regulations require an application not containing an attestation, what must be used?
• What is NCQA's expectation regarding discrimination in credentialing decisions?
• Which item is not typically part of physician credentialing documentation?
• Why is teamwork essential in PCMH?
• How should health IT support PCMH recognition?
• How is care coordination addressed in PCMH standards?
• FCVS is used for verification of education in which residency programs?
• Which domains are commonly evaluated for NCQA PCMH recognition?
• Who can approve a clean file for provisional credentialing?
• Which item is explicitly included in practitioner office site quality standards?
• In a PDSA cycle, which phase involves carrying out the change?
• Which NCQA PCMH domain focuses on coordinating care across providers, settings, and transitions, with timely information sharing and follow-up?
• How do EHR capabilities relate to PCMH recognition?
• Which data element is most directly used to gauge patient access performance?
• What constitutes formal governance in NCQA accreditation?
• Distinguish between a self-assessment and an on-site assessment in NCQA.
• Which of the following is part of the site's quality standard?
• What is the Data Submission Guide (DSG) used for?
• Per NCQA, if the provider has a felony conviction they must...
• Which element helps ensure comparability of performance across different patient populations in NCQA reporting?
• NCQA's policy on board certification for nurse practitioners and other non-physician clinicians is:
• Which elements are included in the organization's performance standards for practitioner office site quality?
• What must be done to confirm board certification status when there is no end date?
• Who can approve a file that is not clean for provisional credentialing?
• What is considered the highest level of training by NCQA?
• What must be on file with NCQA for a provider to perform clinical privileges?
• Which source is listed as an acceptable DEA/CDS verification source for DEA only?
• What does interoperability require for NCQA programs?
• Why is data quality essential in NCQA reporting, and how is it ensured?
• What is required if the practitioner does not prescribe medications that require a DEA or CDS?
• How should data privacy controls be implemented for NCQA data?
• What is the purpose of measurement dashboards in PCMH?
• What does 'Team-Based Care' entail in PCMH?
• Which of the following is NOT an approved source to verify sanctions or limitations on state licenses for podiatrists?
• How often are credentialing and re-credentialing typically performed?
• How does NCQA determine current competence at appointment?
• Which option best describes CAHPS in relation to patient experience?
• Which statement best describes the organization’s policy regarding updating the directory after new practitioner information?
• What is required for provisional credentialing per NCQA?
• What is the NCQA required reappointment time frame?