Cpmsm practice Study guides, Study notes & Summaries

Why it is important to check that the practitioner is not currently excluded suspended the board or in eligible to participate in federal healthcare programs correct answer: The facility won't get paid for treating patients unless service is provided by authorized provider Which of the following credentials must be tracked on an ongoing basis correct answer: Licensure According to NCQA standards and organization that discovers sanction information complaints or adverse events regarding ...

HFAP correct answer: Refers to a CVO as a Professional Credentialing Organization (PCO) HFAP Appointment time frame correct answer: 2 years TJC Appointment time frame correct answer: No longer than every 2 years NCQA Appointment time frame correct answer: 3 years (to the month) URAC Appointment time frame correct answer: 3 years AAAHC Appointment time frame correct answer: 3 years Attestation Statement correct answer: TJC and Medicare do not specifically address, URAC al...

CPMSM Practice Tests / Extras 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 purchasers, regulators and consumers. HEDIS is an element of NCQA accreditation and the basis of consumer report cards for managed care. HEDIS data is collected through a c...

Why is it important to check that the practitioner is not currently excluded, suspended, debarred, or ineligible to participate in Federal health care programs? correct answer: The facility won't get paid for treating patients unless service is provided by authorized provider Which credentials must be tracked on an ongoing basis? correct answer: Licensure According to NCQA standards, an organization that discovers sanction info, complaints, or adverse events regarding a practitioner mus...

Medical Staff correct answer: according to the Joint Commission who is responsible for developing criteria for FPPE when issues affecting the provision of safety patient care are identified. 5 years correct answer: NCQA requires an organization to obtain a claims history for a minimum of how many years every 6 Months correct answer: According to NCQA how frequently must a delegate submit a report to the organization For health plans 180 days, for CVO 120 days correct answer: verific...

CPMSM Practice Test (Latest) Updated Qs & As Graded A+

What does HEDIS stand for? correct answer: Healthcare Effectiveness Data and Information Set What is HEDIS? correct answer: 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 purchasers, regulators and consumers. HEDIS is an element of NCQA accreditation and the basis of consumer report cards for managed care. HEDIS data is collected through a combinat...

According to URAC who should oversee the clinical aspects of the credentialing program within the organization? correct answer: Senior Clinical Staff Person Name 3 sources of verification of education of a dentist according to NCQA correct answer: Dental school, specialty board, state licensing board NCQA requires MCO's to recredential practitioners at least every correct answer: 3 years HFAP is commonly known as correct answer: AOA, an osteopathic organization T/F No accreditat...

CPMSM PRACTICE TEST QUESTIONS WITH CORRECT SOLUTIONS RATED A+ Your insurance agent is John, and who is the principal in this agency relationship? A. None. B. Your insurance company. C. Your insurance agent. D. You. - CORRECT ANSWER-Your insurance company Your insurance company authorizes your agent to do business with you. Statutory Law Defenses are determined by which of the following? A. Judicial decisions. B. Executive decisions. C. Enactment of Legislatures. D. Administrative decisions. ...