DMEC CLMS CERTIFICATION 2026 LIKELY
EXAM QUESTIONS WITH ANSWER
EXPLANATIONS
◉ quality management. Answer: this focusses on customer
satisfaction, prevention of errors, management responsibility,
continuous improvement
◉ quality metrics. Answer: parameters or ways of quantitatively
measuring quantity
◉ variance tracking. Answer: deviations from a standard or
recommended interventions. Helps ID opportunities for
improvement
◉ Continuous quality improvement. Answer: process to attempt to
optimize quality of a system.
◉ plan do study act. Answer: a cyclic 4 step improvement process
that includes gathering data, experimenting, analyzing that data, and
adapting improvements.
,◉ six sigma. Answer: data driven quality management process to
eliminate defects: define, measure, analyze, improve/design,
control/verify
◉ balanced budget act. Answer: act that gives medicare and
medicaid services authority to establish and oversee a program that
allows private, national accredited organizations to "deem" weather
or not a medicare advantage organization is compliant with
medicare requirements. example: JCAHO and NCQA
◉ HEDIS. Answer: tool managed by NCQA used by more than 90
percent of America's health plans to measure performance on
important dimensions of care and service. 80 measures and 5
domains including: effectiveness, access, experience, UR, descriptive
info
◉ HEDIS. Answer: health care effectiveness data information set
◉ patient centered medical home (PCMH). Answer: a care delivery
model whereby patient treatment is coordinated through their
primary care physician to ensure they receive the necessary care
when and where they need it, in a manner they can understand.
◉ national quality forum. Answer: not for profit membership
organization to develop and implement a national strategy for
standardizing health care quality measures and reporting. This
, organization was charged by the affordable care act to create the
national priorities partnership and nursing sensitive care standards
( death of surgery patients, pressure ulcers, falls, restraints, UTIs
urinary catheters), ventilator associated pneumonia, smoking
cessation)
◉ national committee for quality assurance (NCQA). Answer: private
not for profit organization that accredits certain organizations if
they meet standards to improve health care quality. includes a
quality compass to score health plans.
◉ utilization review accreditation commission (URAC). Answer: An
independent nonprofit organization that offers quality benchmark
programs to improve quality and accountability of health care
organizations.
◉ Joint Commission. Answer: not for profit organization that set
performance standards and accredit hospitals, nursing homes, and
ambulatory care clinics for safe and effective care with site visits
every 3 years. Quality Seal.
◉ Magnet. Answer: accreditation developed by ANCC demonstrating
quality nursing leadership and excellence. It focuses on: Quality,
identifying excellence in nursing, and disseminating best practice.
EXAM QUESTIONS WITH ANSWER
EXPLANATIONS
◉ quality management. Answer: this focusses on customer
satisfaction, prevention of errors, management responsibility,
continuous improvement
◉ quality metrics. Answer: parameters or ways of quantitatively
measuring quantity
◉ variance tracking. Answer: deviations from a standard or
recommended interventions. Helps ID opportunities for
improvement
◉ Continuous quality improvement. Answer: process to attempt to
optimize quality of a system.
◉ plan do study act. Answer: a cyclic 4 step improvement process
that includes gathering data, experimenting, analyzing that data, and
adapting improvements.
,◉ six sigma. Answer: data driven quality management process to
eliminate defects: define, measure, analyze, improve/design,
control/verify
◉ balanced budget act. Answer: act that gives medicare and
medicaid services authority to establish and oversee a program that
allows private, national accredited organizations to "deem" weather
or not a medicare advantage organization is compliant with
medicare requirements. example: JCAHO and NCQA
◉ HEDIS. Answer: tool managed by NCQA used by more than 90
percent of America's health plans to measure performance on
important dimensions of care and service. 80 measures and 5
domains including: effectiveness, access, experience, UR, descriptive
info
◉ HEDIS. Answer: health care effectiveness data information set
◉ patient centered medical home (PCMH). Answer: a care delivery
model whereby patient treatment is coordinated through their
primary care physician to ensure they receive the necessary care
when and where they need it, in a manner they can understand.
◉ national quality forum. Answer: not for profit membership
organization to develop and implement a national strategy for
standardizing health care quality measures and reporting. This
, organization was charged by the affordable care act to create the
national priorities partnership and nursing sensitive care standards
( death of surgery patients, pressure ulcers, falls, restraints, UTIs
urinary catheters), ventilator associated pneumonia, smoking
cessation)
◉ national committee for quality assurance (NCQA). Answer: private
not for profit organization that accredits certain organizations if
they meet standards to improve health care quality. includes a
quality compass to score health plans.
◉ utilization review accreditation commission (URAC). Answer: An
independent nonprofit organization that offers quality benchmark
programs to improve quality and accountability of health care
organizations.
◉ Joint Commission. Answer: not for profit organization that set
performance standards and accredit hospitals, nursing homes, and
ambulatory care clinics for safe and effective care with site visits
every 3 years. Quality Seal.
◉ Magnet. Answer: accreditation developed by ANCC demonstrating
quality nursing leadership and excellence. It focuses on: Quality,
identifying excellence in nursing, and disseminating best practice.
