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