Introduction

Question 1

what is NAMSS

Answer 1

National Association of Medical Staff Services (NAMSS)

Question 2

What is CPCS

Answer 2

Certified Provider Credentialing Specialist (CPCS)

Question 3

What is NAMSS’ vision

Answer 3

To advance a healthcare environment that maximizes the patient experience through the delivery of quality services.

Question 4

who ultimately makes the decisions in The Hospital environment

Answer 4

Board of Trustees & MEC - Medical Executive Committee

Question 5

Name the 4 factors that influence hospital credentialing

Answer 5

-federal/state laws and regulations
-accreditation standards
-hospital and medical staff bylaws/rules/regulations/policies
-standard of care

Question 6

Name 3 examples of federal/state laws that influence hospital credentialing

Answer 6

-HCQIA (Health Care Quality Improvement Act
-CoP’s (Medicare Hospital Conditions of Participation)
-State licensing regulations

Question 7

What is The Healthcare Quality Improvement Act, and what year did it pass

Answer 7

The federal HCQIA was passed by Congress in 1986 to extend immunity to good faith peer
review of physicians and dentists and to create the National Practitioner Data Bank (NPDB).

Question 8

The HCQIA was enacted due to what federal case

Answer 8

The statute was enacted as a result of the decision
in Patrick vs. Burgett, a federal antitrust case in which physicians were held liable for damages
caused to Dr. Patrick by abusive and inappropriate peer review.

Question 9

What are the 4 different accreditation standards

Answer 9

• The Joint Commission (TJC)
  -Healthcare Facilites Accreditation Program (HFAP)
  -Center for Improvement in Healthcare Quality (CIHQ)
  -Det Norske Veritas (DNV)

Question 10

what are Health Plans or Provider Organizations examples of

Answer 10

Managed Care Organizations (MCO’s) - commercial third-party payers, healthcare networks or health plans

Question 11

what 6 factors influence credentialing in health plans

Answer 11

• accreditation standards
• federal/state laws and regulations
  -healthcare effectiveness data and information (HEDIS)
• Consumer assessment of Healthcare Providers and systems (CAHPS)
  -Policies and procedures
  -standard of care

Question 12

What are the 2 types of accreditation standards for an MCO

Answer 12

-National Committee for quality assurance (NCQA)
-URAC Utilization review accreditation commission (URAC)

Question 13

What 5 factors influence credentialing a CVO

Answer 13

CVO - Credential Verification Organization
-Contracts
-Accreditation standards
-CMS regulations
-Policies and procedures
-Federal/state laws and regulations

Question 14

What are the 7 different types of accreditation standards for a CVO

Answer 14

CVO - Credential verification organization
-AAAHC Accreditation Association for Ambulatory Health Care
-HFAP - Healthcare Facilites Accreditation Program
-TJC - The Joint Commission
-CIHQ - Center for Improvement in Healthcare Quality
-NCQA - National Committee for Quality Assurance
-URAC - Utilization review accreditation commission

Question 15

What are the 2 types of CVO’s

Answer 15

-Organization specific
-Independent

Question 16

What 6 factors influence credentialing in Ambulatory Care/Medical Office/Surgical Center

Answer 16

-Accreditation standards
- CMS Regulations
-Federal/state laws
-Policies and procedures
-Contractual agreements
-governance documents including bylaws and policies

Question 17

what are the 4 types of accreditation standards for ambulatory care/surgical centers?

Answer 17

-HFAP Healthcare Facilites Accreditation Program
-TJC - The Joint Commission
- NCQA - National Committee for Quality Assurance
-URAC - Utilization review accreditation commission