MCO acronym for - ACCURATE ANSWERS Managed Care Organization - main accreditors: NCQA, URAC
NAMSS acronym for - ACCURATE ANSWERS National Association of Medical Staff Services
CPCS acronym for - ACCURATE ANSWERS Certified Provider Credentialing Specialist
CVO acronym for - ACCURATE ANSWERS...
CPCS EXAM QUESTIONS |
ACCURATE ANSWERS |
GUARANTEED PASS
MCO acronym for - ACCURATE ANSWERS✔✔ Managed Care
Organization - main accreditors: NCQA, URAC
NAMSS acronym for - ACCURATE ANSWERS✔✔ National
Association of Medical Staff Services
CPCS acronym for - ACCURATE ANSWERS✔✔ Certified Provider
Credentialing Specialist
CVO acronym for - ACCURATE ANSWERS✔✔ Credential
Verifications Organization
HEDIS acronym for - ACCURATE ANSWERS✔✔ Healthcare
Effectiveness Data Information Set
CAHPS acronym for - ACCURATE ANSWERS✔✔ Consumer
Assessment of Healthcare Providers & Systems
Structure of a CVO - ACCURATE ANSWERS✔✔ Director - Contract
Sales - Credentialing Staff - Human Resources
,Structure of a MCO - ACCURATE ANSWERS✔✔ Director - Contracts
Management - Client Services
- Financial Management - Network Admin
Definition of CVO per Industry terms - ACCURATE ANSWERS✔✔
Commercial third party payers, healthcare networks, and health plans
2 types of CVO - ACCURATE ANSWERS✔✔ Organization Specific
Independent
Medicare CoPs (CCJET) - ACCURATE ANSWERS✔✔ Character
Competence
Judgement
Experience
Training
Definition of Compliance - ACCURATE ANSWERS✔✔ Comply with
accredited atom and regulatory standards (i.e. Audits, Obtain & evaluate
sanctions, etc)
Reasons for Credentialing - ACCURATE ANSWERS✔✔ Patient safety
Risk management
Accrediting & Regulatory Agencies
,Definition of CoP's - ACCURATE ANSWERS✔✔ Medicare Conditions
of Participation: Code of Federal Regulations intended to protect patient
health & safety
TJC - definition of Credentialing - ACCURATE ANSWERS✔✔ Process
of obtaining, verifying & assessing the qualifications of a healthcare
practitioner who seeks to provide patient care services for a hospital
NCQA definition of Credentialing - ACCURATE ANSWERS✔✔
Process by which an organization reviews and evaluates qualifications of
a LIP to provide services to its members
Reasons to get accredited - ACCURATE ANSWERS✔✔ Quality of care
Accrediting bodies
Deemed Status - participation in Medicare/Medicaid
Liability insurance premiums
Managed care contracts
Unions may require for healthcare to employees
Basics of Bylaws - ACCURATE ANSWERS✔✔ Unique to each
hospital
Guidelines serve to ensure compliance
Regular review required
Bylaw changes not effective until board approved
State requirements may influence
, CMS Rule for Governing Body - ACCURATE ANSWERS✔✔
Governing Body has authority to approve/disapprove bylaws suggested
by med staff and revisions before approving
Rules & Regs - ACCURATE ANSWERS✔✔ Detail what med staff
appointees may or may not do
Med staff may delegate authority to change rules/regs to MEC
Hospital Credentialing Organizations - ACCURATE ANSWERS✔✔
TJC, DNV, HFAP
Policies & Procedures - ACCURATE ANSWERS✔✔ Describe course
or conduct/action/management of a matter or circumstance.
Often address internal matters
MCO Credentialing Organizations - ACCURATE ANSWERS✔✔
NCQA, URAC
NCQA - Time limit for verification of Board Certification - ACCURATE
ANSWERS✔✔ 180 days, 120 for CVO
URAC - Time limit for verification of Board Certification - ACCURATE
ANSWERS✔✔ 6 months
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