What is CPCS?
CPCS stands for Certified Provider Credentialing Specialist, and this NAMSS certification shows that the CPCS healthcare worker is a tested and proven expert in their credentialing field.
Medical credentialing is the process that verifies that a healthcare provider is appropriately trained and qualified to treat patients. The vetting procedure can help protect healthcare organizations and patients from negligent providers.
Medical errors kill more than 200,000 people in the United States each year. Credentialing can help reduce those errors, mitigating the risks of medical malpractice. The people who credential healthcare providers are certified to do so as well.
The National Association of Medical Staff Services (NAMSS) provides certified provider credentialing specialist (CPCS) certification to people seeking employment in the credentialing industry. CPCS certification proves to potential employers that a person possesses the skills and knowledge required to perform provider credentialing.
Certified provider credentialing specialists perform numerous duties that include:
- Carefully handling confidential information.
- Maintaining compliance with accrediting and regulatory bodies.
- Developing and employing credentialing processes and procedures.
- Credentialing healthcare providers.
- Reviewing applications and verification letters.
- Maintaining relevant databases that contain providers’ data.
Certified provider credentialing specialists typically have an associate degree in medical staff services or similar fields. They must possess excellent written, verbal, and organizational skills. They should also have a high degree of integrity due to the confidential nature of the work. Certified provider credentialing specialists are usually employed by healthcare organizations such as hospitals, group practices, and credentialing verification organizations.
How does one obtain CPCS certification?
Candidates must pass the CPCS exam to become certified. The exam is developed to assure employers that candidates possess the knowledge and abilities to work across all medical services and credentialing fields. Currently, re-certification is required every three years. Continuing education may be necessary to keep up with current regulations and qualifications.
CPCS candidates must qualify before they can take the exam and must:
- Be employed in the medical services profession for at least 12 consecutive months in the last 24 months.
- Have three years of experience in the medical services profession within the past five years.
The CPCS exam specifically covers the areas of credentialing, privileging, and primary source verification. Candidates must have current and direct involvement with the application of accreditation standards and conducting credentialing activities to complete certification. The exam itself contains 150 multiple-choice questions. There will be one correct answer and two incorrect answers. There are no trick questions, but the two wrong answers are plausible enough to distract from the correct one. There are three testing periods – spring, summer, and fall. The spring period typically occurs in March and April, the summer period in June and July, and the fall period in October and November.
How long does certification take?
While an associate degree is not required for any specific medical credentialing job, many employers prefer candidates who have obtained one. These degree programs usually take two years to complete. Courses typically include anatomy and physiology, medical law, terminology, management, and medical staff services.
Some programs allow students to work with an employer to gain professional experience. Some employers may prefer a bachelor’s degree, which takes longer to earn depending on the candidate’s academic acumen and personal schedule. To be eligible for the CPCS exam, candidates must have three years of medical service experience, including the last 12 months being consecutive.
The computer-based exam itself takes up to 3 hours to complete. Results will be emailed to candidates approximately 6 to 8 weeks from the close of the testing window. The closing of the testing window may be up to three weeks after a candidate’s testing date.
How much does CPCS cost?
In addition to the costs of obtaining an associate degree (if a candidate chooses), taking the CPCS costs non-NAMSS members $500 and NAMSS members $375. The fees for CPCS re-certification are $175 for non-NAMSS Members and $175 for members. There are also rescheduling, transfer, late, and cancellation fees that are $100 each.
There are two types of NAMSS memberships with discount implications:
- Active Membership costs $185 per calendar year, depending on when the candidate joins.
- Affiliate Membership costs $110 per calendar year, depending on when the candidate joins.
The benefits of NAMSS membership include the following:
- Access to members-only events
- Resources and tools to help expand your knowledge across the credentialing field
- Online networking opportunities
- The CPCS exam discount
Why pursue CPCS certification?
- CPCS certification increases the potential for advancement in any healthcare environment.
- Someone who is CPCS-certified can enjoy salary increases and higher recognition among their peers.
- CPCS can enhance a credentialing specialist’s value and job security.
What is CPMSM?
CPMSM stands for Certified Professional Medical Services Management, and this NAMSS certification shows that the CPMSM healthcare manager is a tested, qualified and proven leader in their field. A healthcare organization must verify that a healthcare provider is qualified to treat patients. Every year, medical errors kill almost a quarter of a million people in the United States. Medical credentialing can help reduce those mistakes, potentially lowering medical malpractice risks. The credentialing process can help protect healthcare organizations and patients alike. The medical services professionals who credential healthcare providers must also be qualified to perform their jobs.
The National Association of Medical Staff Services (NAMSS) offers certified professional medical services management (CPMSM) certification to medical service professionals who wish to work in the credentialing industry. This is one of several NAMSS certifications that are the only National Commission for Certifying Agencies accredited certifications for the medical services industry.
CPMSM certification shows employers that a potential employee can successfully work in medical services management. CPMSM credentialing certification proves that the medical services professional possesses knowledge of healthcare credentialing, governance, and regulatory compliance.
CPMSM-certified professionals may perform the following job duties:
- Ensuring compliance with regulatory and accrediting entities
- Developing and applying credentialing and privileging processes and procedures
- Creating and using provider enrollment processes and procedures
- Overseeing the development of department regulations
- Ensuring adherence to the rules concerning medical staff and the organization as a whole
How does one become CPMSM certified?
Health systems usually employ CPMSM-certified professionals, managed care organizations, credentials verification organizations, or wherever the staff performs the management functions of medical services and compliance with accrediting standards. This certification is basically for professionals who participate in managerial roles. CPMSM candidates must be employed in the medical service industry for at least 12 consecutive months within the last 24 months and have five years of experience working in the industry within the past eight years. Candidates must pass a written exam. The exam is meant to assure employers that candidates have the knowledge and abilities to work across all medical services and credentialing industry areas successfully.
The CPMSM exam does NOT cover the following:
- Billing
- Physician practice management
- Credentialing Software Development
- Physician staffing outside the functions of primary source verification
The exam itself contains 175 multiple-choice questions. There will be one correct answer and two incorrect answers. Three testing periods take place in spring, summer, and fall. The spring period usually happens in March and April. The summer period happens in June and July. The fall period occurs in October and November.
After an application for an exam has been approved, an email will be sent to the candidate to schedule the exam. Candidates can select an exam site, date, and time from the list of available sites. Appointment times are on a first-come, first-served basis. There are more than 300 testing centers in the United States. If a candidate’s requested place and date are no longer available, they will receive an email notice granting them the option to choose another location and date. CPMSM re-certification is required every three years. Continuing education may be necessary for professionals to maintain their knowledge of current regulations and qualifications.
How long does CPMSM certification take?
In addition to the qualifications stated above that require a year of working in the industry, certification exam candidates will have 4 hours to finish the exam. Results will be emailed to candidates around 6 to 8 weeks from the end of the testing window. The end of the testing window may take place up to 3 weeks after a candidate’s testing date.
How much does CPMSM cost?
There is a practice exam available that candidates may take before taking the actual exam. The CPMSM Online Practice Exam costs $50. Once purchased, candidates have 48 hours to access it. The practice exam was designed using the same specifications as the certification exam. The practice exam comprises 50 multiple-choice questions intended to provide candidates with a sample of the questions on the actual exam. No practice questions are in the certification exam. Once the exam is accessed, candidates have 4 hours to complete it – the same amount allotted for the actual exam.
The CPMSM exam costs $500 for non-NAMSS members and $375 for NAMSS members. The fees for CPMSM re-certification are $300 for non-NAMSS members and $150 for members. Exam rescheduling, transfer, late, and cancellation fees are $100 each.
Active and Affiliate Memberships are the two types of NAMSS memberships offering discounts include:
- Active Memberships cost $185 per calendar year, depending on when the candidate signs up.
- Affiliate Memberships cost $110 per calendar year, depending on when the candidate signs up.
NAMSS membership benefits include the following:
- Access to members-only events and publications.
- Resources to help increase knowledge across the credentialing field.
- Exclusive networking opportunities.
- The CPMSM exam discount.
Why obtain CPMSM certification?
- CPMSM credentialing certification can increase a medical services professional’s chances of advancing in any healthcare workplace.
- CPMSM usually results in higher pay for the certified employee.
- CPMSM-certified providers typically communicate management processes and procedures with physicians and staff members more effectively.
What is the difference between CPCS and CPMSM?
What is the difference between CPCS and CPMSM? While the CPCS exam focuses on accreditation standards and credentialing verification requirements, the CPMSM exam encompasses leadership, meeting management, Robert’s Rules, budgeting, fair hearing, and precedent-setting legal cases that impact the industry.
More information about 5ACVO
5ACVO is an NCQA Credentialing Accredited specializing in credentialing and primary source verification and is part of the Fifth Avenue Healthcare Services family. 5ACVO sister companies include Fifth Avenue Agency (MPLI and medical malpractice insurance specialists) and Primoris Credentialing Network (credentialing and provider enrollment specialists with 54+ health plan and network provider enrollment options).
5ACVO originally published this article here. For more information on 5ACVO, please visit 5ACVO.com or Contact Us.
