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Why is it important to check that the practitioner is not currently excluded, suspended, debarred, or ineligible to participate in Federal health care programs? - The facility will not get paid for treating patients unless service is provided by an authorized provider Which of the following crede...

What are four models of HMOs? - Staff Model Group Model Network Model Independent Practice Association (IPA) What are the four types of committees? - Standing Ad hoc Task force Continuous quality improvement t

According to URAC who should oversee the clinical aspects of the credentialing program within the organization? - Senior Clinical Staff Person Name 3 sources of verification of education of a dentist according to NCQA - Dental school, specialty board, state licensing board NCQA requires MCO's t...

Where must accreditors submit their standards for approval? - CMS When is deemed status given? - After approval by CMS What are requirements set by forces outside the organization? - External criteria What factors are defined by the hospital's medical staff and governing body or the MCO's board...

Does not specifically addressed in the standards health status and Nondiscrimation a.TJC b.HFAP c.DNV GL D.NCQA - DNV GLS How many peer references does HFAP require at initial appointment? - 1 According to NCQA what requires ongoing monitoring between recredentialing cycles? - Medicare/Medica...

Are limitations of the clinical privileges of a psychiatrist for more than 30 days reportable to the NPDB? - Yes According to the Joint Commission, who may amend the medical staff bylaws? - Governing Body Failure to meet the established qualifications and criteria for appointment should be report...

Applicant completes an application that includes, reasons for inability to perform, las of present illegal drug use, loss of license or felony convictions. Loss or limitation of privileges or disciplinary actions. Current malpractice insurance coverage, current signed attestation confirming the co...

What does HEDIS stand for? - Healthcare Effectiveness Data and Information Set What is HEDIS? - is a widely used set of performance measures in the managed care industry. HEDIS is a multipurpose tool originally designed to address private employers' needs and has been adopted by public purchaser...

Why is it important to check that the practitioner is not currently exclude, suspended, debarred, or ineligible to participate in Federal health care programs? - The facility will not get paid for treating patients unless the service is provided by an authorized provider. Which of the following c...