NAMSS CPCS book

Question 1

What is NAMSS

Answer 1

NAMSS is celebrating more than 30 years of enhancing the professional development of and recognition for professionals in the medical staff and credentialing services field. NAMSS membership includes more than 4,500 medical staff and credentialing services professionals from medical group practices, hospitals, managed care organizations, and CVOs.

Question 2

Four Topics

Answer 2

Principles of credentialing and re-credentialing
Operations and information management
Healthcare Law
Developing your study strategy

Question 3

Factors that influence hospital credentialing

Answer 3

federal state law and regulations, HCQIA, Hospital COPs, State licensing regulations, accreditation standards (DNV, HFAP, TJC), hospital and medical staff bylaws or rules/regs, Standard of Care (legal aspect)

Question 4

What is a Managed Care Organization

Answer 4

A broadly used industry term to collectively describe commercial third party payers, healthcare networks and health plans.
Variety of influences on credentialing including accreditation standards, federal/state laws/regulations, HEDIS/CAHPS, Policies & Procedures, Standard of Care (legal aspect)

Question 5

What is a CVO?

Answer 5

Credentials Verification Organization - many factors influence the credentialing process including contracts, accreditation standards, policies and procedures, federal/state laws & regs
Two types of CVO’s
A CVO associated with a specific healthcare organization & independent CVO

Question 6

Ambulatory Care, Medical Office or Surgical Center Credentialing

Answer 6

Structure of these organizations vary depending on size - influenced by: accreditation standards, AAAHC, HFAP, TJC, NCQA, URAC, Federal/State laws & regs, policies and procedures, contractual agreements