Aaahc Study guides, Class notes & Summaries

What two accreditors state: a hospital may not rely solely on board certification when considering practitioner for medical staff membership? - HFAP, CMS According to JC & HFAP name four approved sources PSV for Medical Education - Medical School, AMA, ECFMG, AOA According to NCQA practitioners must be notified of credentialing decision within how many days? - 60 Days The DHHS mails a copy of the NPDB report to the named provider. If the provider wishes to dispute the reports accuracy, ...

CPCS Exam 2023 Latest Update MCO acronym for - Managed Care Organization - main accreditors: NCQA, URAC NAMSS acronym for - National Association of Medical Staff Services CPCS acronym for - Certified Provider Credentialing Specialist CVO acronym for - Credential Verifications Organization HEDIS acronym for - Healthcare Effectiveness Data Information Set CAHPS acronym for - Consumer Assessment of Healthcare Providers & Systems Structure of a CVO - Director - Contract Sales - Credentialing ...

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 reported to whom? - The applicant NCQA requires the MCO to obtain a minimum of ???? years of work history? - 5 years According to NCQA what policy must an organization have in place to obtain approval to...

Privacy Act of 1974 correct answer: requires federal agencies holding personal identifiable records to safeguard that information and provide individuals with certain privacy rights. HIPAA Privacy Rule correct answer: Effective April 2003 Administrative Rule correct answer: Is administrative law, provides greater detail from the statute in which it was created. HIPAA Security Rule correct answer: Effective April 2005 ARRA (American Recovery and Reinvestment Act) correct answer: ...

CPMSM - Study Guide MaterialWhat are four models of HMOs? - correct answer Staff Model Group Model Network Model Independent Practice Association (IPA) What are the four types of committees? - correct answer Standing Ad hoc Task force Continuous quality improvement team How many medical staff members comprise a Bylaws Committee? - correct answer 5 At least five active medical staff How many medical staff members comprise a Credentials Committee? - correct answer 5 At least f...

CPCS Certified Provider Credentialing Specialist (2023/2024) Graded A What elements should a peer recommendation include according to TJC? Patient Care, medical clinical knowledge, practice based learning, interpersonal and communication skills, system-based practice Peer recommendations according to NCQA There is no specific requirement for peer recommendations. The organization must designate a Credentialing Committee that uses a peer-review process to make recommendations regarding credentia...

CPCS Exam 2023 Questions and Answers Rated A+ TJC (The Joint Commission) Definition of Credentialing The process of obtaining, verifying, and assessing the qualifications of a health care practitioner who seeks to provide patient care services in or for a hospital. NCQA (National Committee for Quality Assurance) definition of credentialing process by which an organization reviews and evaluates qualifications of licensed independent practitioners to provide services to its members. Should you u...

CPCS/CPMSM Sample Questions 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 reported to whom? - The applicant NCQA requires the MCO to obtain a minimum of ???? years of work history? - 5 years According to NCQA what policy must an organiza...

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 medical staff bylaws? - Medical Staff Failure to meet the established qualifications and criteria for appointment should be reported to whom? - The applicant NCQA requires the MCO to obtain a minimum of ______ years of work history? - Five years According to NCQA what policy must an organization have in place to obtain approval...

CPMSM HFAP stands for? - correct answer Healthcare Facilities Accreditation Program (Accrediting organization for AOA. Provides accreditation programs for primarily osteopathic hospitals) The following bodies approves clinical privileges? - correct answer Governing Body or Board Which NCQA-required committee makes recommendations regarding credentialing decisions? - correct answer Credentialing Committee What primary source verification is required by NCQA prior to temporary privileges/...