CPCS Exam 2023 Already Graded A

CPCS Exam 2023 Already Graded A 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 Staff - Human Resources Structure of a MCO Director - Contracts Management - Client Services - Financial Management - Network Admin Definition of CVO per Industry terms Commercial third party payers, healthcare networks, and health plans 2 types of CVO Organization Specific Independent Medicare CoPs (CCJET) Character Competence Judgement Experience Training Definition of Compliance Comply with accredited atom and regulatory standards (i.e. Audits, Obtain & evaluate sanctions, etc) Reasons for Credentialing Patient safety Risk management Accrediting & Regulatory Agencies Definition of CoP's Medicare Conditions of Participation: Code of Federal Regulations intended to protect patient health & safety TJC - definition of Credentialing Process of obtaining, verifying & assessing the qualifications of a healthcare practitioner who seeks to provide patient care services for a hospital NCQA definition of Credentialing Process by which an organization reviews and evaluates qualifications of a LIP to provide services to its members Reasons to get accredited Quality of care Accrediting bodies Deemed Status - participation in Medicare/Medicaid Liability insurance premiums Managed care contracts Unions may require for healthcare to employees Basics of Bylaws Unique to each hospital Guidelines serve to ensure compliance Regular review required Bylaw changes not effective until board approved State requirements may influence CMS Rule for Governing Body Governing Body has authority to approve/disapprove bylaws suggested by med staff and revisions before approving Rules & Regs Detail what med staff appointees may or may not do Med staff may delegate authority to change rules/regs to MEC Hospital Credentialing Organizations TJC, DNV, HFAP Policies