CORE BODY OF KNOWLEDGE (CBK)

In order to fulfill the education requirement for the certification examination, most examinees take advantage of the Core Body of Knowledge (CBK) Independent Study Course.

This course has been produced online for your convenience. You can work from the comfort of your own home, at a time you choose. When you have successfully completed your course, you will be able to immediately print your CE certificate.

This course is intended for Physicians of all specialties, Nurses, and Other Health Care Professionals with appropriate CME and CEU credit offered for each profession. While the Board recommends this course as a valuable overview of Health Care Quality Management (HCQM), it is not required and does not ensure successful completion of the examination.

The key concepts to be discussed are the following:

Participants Will Learn To...

• Identify the distinguishing characteristics of various forms of private and public health insurance and health insurance products
• Understand publicly funded health programs such as Medicare, Medicaid, Tricare, Indian Health Service
• Examine the impact of Managed Care on Quality and Utilization
• The states and federal Workers’ Compensation systems
• The impact of Americans With Disabilities Act (ADA) upon the injured worker
• The legal requirements an employer needs to follow when hiring a new worker
• The fairness of the “Systems” to the injured worker
• The legal aspects of the systems regulating/governing the injured/disabled worker
• What Permanent Partial Impairment (PI), Permanent Impairment (PI), Permanent Partial Disability (PPD), Permanent Disability (PD) and Temporary Total Disability (TTD) mean to the injured worker
• An Overview of Workers’ Compensation Federal Employees’ Compensation Act, Railroad, Maritime Workers, covered under Federal Employers’ Liability Act (FELA) and the Jones Act and the Obligations of ADA
• Explain the various ways utilization is managed and costs are controlled
• Explain the Center for Medicare and Medicaid Services (CMS, formerly the Health Care Financing Administration) efforts to identify misutilization with utilization profiles, protections for relaters and audits in both the public and private sectors
• Discuss how CMS has restored the Medicare Trust Fund through the enforcement of local and national policy
• Discuss case management components, including demand and disease management
• Explain the significance of ERISA (Employee Retirement Income Security Act), OBRA (Omnibus Budget Reconciliation Act of 1993), COBRA (Consolidated Omnibus Budget Reconciliation Act), TEFRA (Tax Equity and Fiscal Responsibility Act), CLIA (Clinical Laboratory Improvement Amendments), HIPAA (Health Insurance Portability and Accountability Act), and the BBA (Balanced Budget Act)
• Define the evolution and use of the PPS (Prospective Payment System), DRGs (Diagnosis Related Groups), APGs (Ambulatory Patient Groups), and Evaluation and Management Coding
• Address Title XIX of the Social Security Act and the inception of Medicare along with major changes and present challenges
• Identify the significance of the Health Care Quality Improvement Act (HCQAI) and its amendments, the National Practitioner Data Bank, and the Healthcare Integrity and Protection Data Bank
• Illustrate how the HCQIA and its amendments have affected credentialing, de-credentialing and re-credentialing
• Discuss major postulates established by case laws and statutes and their influence on practitioners in the health care system
• Discuss the evolution and the benefits of accreditation
• Define “deeming” authority and identify the health care areas for which deemed status options are available
• Discuss the differences between accrediting organizations and regulatory agencies
• Familiarity with the purpose and goals of various accrediting bodies active in health care today
• Describe the use of The Health Plan Employer Data and Information Set (HEDIS®) in quality improvement
• Outline concepts essential for proper credentialing of health care providers authorized by organizations to care for patients, e.g., hospitals, ambulatory care centers, health plans, workers’ compensation provider panels
• Specify how privileges are granted, maintained and how they may be removed
• Explain the concept and importance of primary source verification
• Name the different resources that should be consulted to assure an applicant’s provision of safe care and ethical billing practices
• Explain the components necessary for periodically re-credentialing and re-privileging individuals already authorized by the organization to provide patient services
• Discuss fair hearing principles
• Define risk management as it relates to practitioners, managed care organizations and health care facilities
• Peruse risk management statutes, amendments, regulations and strategies used to reduce the exposure of risk and decrease the probability of a malpractice lawsuit to both organizations and practitioners
• Discuss tort reform and methods to effect tort reform
• Clarify the role of governing bodies in protecting the financial assets and in reducing liabilities of health care organizations
• Examine the purpose and principles of the Medical Staff Bylaws in reducing liability
• Discuss the parameters of Informed Consent and the Patient Bill of Rights
• Determine how to protect your medical license should risk management strategies fail
• Recount the elements of a medical malpractice claim and explain the reasons why lawsuits settle
• Examine how practitioners can determine if managed care contracts leave them vulnerable
• Define the implications of Stark, Anti-Kickback Statute, and State Anti-Referral Restrictions
• Review the elements of an effective compliance plan
• To understand the purpose of HIPAA legislation
• To review some of the difficulties in HIPAA compliance
• To review the penalties for non-compliance with HIPAA
• To consider the impact of HIPAA regulations on medical practice
• Review the Institute Of Medicine’s report “To Err is Human” and its impact on Patient Safety
• Explore the many causes of medical error
• Explore Computer Physician Order Entry (CPOE) Systems
• Review the Leapfrog Group purchasers’ initial methods to improve patient safety
• Review The Leapfrog Group's CPOE Patient Safety Standard

Accredited Learning
The American Board of Quality Assurance and Utilization Review Physicians, Inc. is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. ABQAURP takes responsibility for the content, quality, and scientific integrity of this CME activity.

The American Board of Quality Assurance and Utilization Review Physicians, Inc. designates this educational activity for a maximum of 13 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The American Board of Quality Assurance and Utilization Review Physicians, Inc. is an approved provider with the Florida Board of Nursing to provide continuing education for nurses. This activity has been approved for 15.6 contact hours by the Florida Board of Nursing, Provider # 50-94.