Urac standards - Study guides, Class notes & Summaries

CPCS - Certified Provider Credentialing Specialist Questions and Answers 100% Pass Are limitations of the clinical privileges of a psychiatrist for more than 30 days reportable to the NPDB? Yes According to TJC, who may amend the medical staff bylaws? Governing body/board. 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 how may years of work history? Five years According to the...

URAC Utilization Review Accreditation Committee Question and answers 100% correct 2023/2024What is URAC? - correct answer It is a non profit organization that helps to promote healthcare quality through the accreditation of organizations involved in medical care services. URAC, how many years before the next credentialing? - correct answer URAC gives up to three years What happens after three years? - correct answer The organization must go through another review. When was URAC founded?...

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...

What must the application include per URAC? - Disclosure of any physical, mental or substance abuse problems that could, without reasonable accommodation, impede the practitioners ability to adhere to the accepted standards of professional performance or pose a threat to the health or safety of patients. Per URAC organizations must verify the qualifications of all AHPs that? - Provide clinical services to consumers through a written agreement with the organization Per URAC who must be cred...

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 ...

AAPC - Medical Terms for Billing & CodingAblation - correct answer Erosive process is performed surgically to eliminate or remove Abuse - correct answer A range of the following improper behaviors or billing practices including, but not limited to: billing for a non-covered service: misusing codes on the claim (i.e., the way the service is coded on the claim does not comply with national or local coding guidelines or is not billed as rendered); or inappropriately allocating costs ...

CPCS 2018 Practice Exam 2 Questions & Answers URAC standards require primary source verification of which two elements when initially credentialing a provider? - ANSWERSa. State licensure & Board certification or highest level of education. b. Medical malpractice claims & Professional liability coverage c. Health status & Ability to perform privileges requested True/False: AOA-HFAP standards allow a hospital to accept the credentialing and privileging decision of another organization...

URAC Question and answers rated A+ 2023/2024Credentialing Program - correct answer covers all practitioners who are participating providers and are providing health care services Credentialing may be delegated to - correct answer 1. a contracted network 2. a group 3. a clinic Delegation oversight is required and delegated entity must be performing credentialing according to URAC standards URAC -The following credentials must be collected for health care facilities that are credentialed ...

1. The BoP is under the Dept of ___ 2. The Agency for Health Care Admin Division of Quality Assurance deals with ___ and ___ 3. The State Ins Commissioner ensures ___ with state laws 4. Most pharmacy laws regulated at ___ level correct answers1. Health 2. Medicare/caid 3. compliance 4. state 1. Accreditation: ___ standards 2. Joint Commission deemed status for ___ 3. Natl Cmte on Quality Assurance (NCQA) utilizes Healthcare Effectiveness Data and Info Set to evaluate ___ 4. Utilizati...

AAPCC - Adjusted Average Per Capita Cost correct answer: The basis for Health Maintenance Organization (HMO) or Competitive Medical Plan (CMP) reimbursement under Medicare-risk contracts. The average monthly amount received per enrollee is currently calculated as 95 percent of the average costs to deliver medical care in the fee-for-service sector. It is the Centers for Medicare & Medicaid Services' (CMS's) best estimate of the amount of money care costs for Medicare recipients under fee-for-...