Certified Provider Credentialing Specialist (CPCS) Practice Exam

The verification time limit for Medicare/Medicaid sanctions according to the National Committee for Quality Assurance (NCQA) is set at 180 days. This means that any sanctions or adverse actions taken against a provider by Medicare or Medicaid should be verified within this time frame.

This 180-day limit is significant because it ensures that healthcare organizations stay current with provider credentials and any potential issues that could affect patient safety and care quality. Timely verification supports compliance with regulations and helps maintain high standards in the healthcare system. Organizations are expected to perform routine checks of provider credentials, and adhering to this timeframe ensures that any relevant sanctions are identified and addressed promptly as part of the credentialing process.

The options representing shorter or longer verification intervals may not align with NCQA’s guidelines, which specifically emphasize the importance of the 180-day limit to ensure accuracy and reliability in credentialing practices.