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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 f...

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...

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 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...

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...

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...