Cpmsm 2023 - Study guides, Class notes & Summaries

AAAHC Accreditation Association for Ambulatory Health Care Formed in 1979. Ambulatory means the same as outpatient or overnight stay. It is the preeminent leader in developing standards to advance and promote patient safety, quality and value for ambulatory health care through peer-based accreditation processes, education and research. Accreditation is ultimately awarded to organizations that are found to be in compliance with their standards. With a single focus on the ambulatory care comm...

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 team How many medical staff members comprise a Bylaws Committee? 5 At least five active medical staff How many medical staff members comprise a Credentials Committee? 5 At least five active medical staff How many medical staff members must serve on an ...

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 correctness and completeness of the application. If an application from an external entity is used it must include the questions and attestations as identified above. Signature stamps are not acceptable u...

NPDB National Practitioner Databank NPDB Contains: (what type of info) - adverse licensure - clinical privilege actions - membership actions (professional/society) - paid malpractice judgements - exclusions from Medicare/Medicaid - actions by US DEA What must Hospitals and Other Health Care Entities report on for Physicians & Dentists (3 things), and how quickly must it be reported? - Professional review actions based on competence, conduct, affecting privs >30 days - v...

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 correctness and completeness of the application. If an application from an external entity is used it must include the questions and attestations as identified above. Signature stamps are not acceptable u...

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 credentials must be tracked on an ongoing basis? Licensure According to NCQA standards, an organization that discovers sanction information, complaints, or adverse events regarding a practit...

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 ...

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