Urac standards - Study guides, Class notes & Summaries

CPMSM Acronyms Exam Questions With 100% Correct Answers Latest 2024/2025 (Graded) Accreditation Association for Ambulatory Health Care - Correct answer-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 fou...

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 - 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...

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 ...

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...

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 ...

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-...