EXAM HIGHLIGHTS

The examination contains factual material, application of concepts and realistic vignettes. The examination is reviewed and updated annually by a committee of

Health Care

 Quality Management experts.

Key concepts covered in the examination include:

Accreditation Organizations

NCQA & HEDIS

JCAHO

AAAHC & AAASF

URAC

ABQAURP

P4P

Leapfrog Group

Bridges to Excellence

Integrated Healthcare Association

Insurance and Managed Care

Consumer Directed Health Care

Tricare

Indemnity

HMO

Medicare

Medicaid

PPO, Point of Service, EPO

Case Management

Workers' Compensation

Compensability

Independent Medical Exams

Return To Work

Safety Programs

Impairment

IME

Second Opinion

Clinical Resource Management

Utilization Review

Predictive Modeling / Management

Medicare Audits

Demand & Disease Management

Credentialing and Privileging

Core Concepts

NPDB

Re-credentialing

Quality Improvement, Management and Assurance

PRO

QISMC

Best Practices

Pathways

Peer Review

Statistical Process Control

CQI & TQM

Theories

Risk Management

Stark Laws

Anti-Kickback Statutes

Anti-Referral Laws

Safe Medical Devices

PSDA

ADA

Tort Reform

Informed Consent

Patient Bill of Rights

Patient Safety

Root Cause Analysis (RCA)

Computer Physician Order Entry (CPOE)

Regulatory Environment

ERISA, COBRA, PPS,

DRGs

Health Care Quality Improvement Act

HIPAA

MS