EXAM TOPICS
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
  • American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP)
  • National Committee for Quality Assurance (NCQA)
  • Healthcare Effectiveness Data and Information Set (HEDISĀ®)
  • The Joint Commission
  • Accreditation Association for Ambulatory Health Care (AAAHC)
  • American Association for Accreditation of Ambulatory Surgery Facilities, Inc. (AAASF)
  • URAC

Transitions of Care
  • National Strategies
  • Project BOOST
  • Project RED
  • Patient Protection & Affordable Care Act (PPACA)
  • American Recovery & Reinvestment Act (ARRA)
  • Seven Essential Elements
  • Readmission Avoidance

Pay-for-Performance
  • Leapfrog Group
  • Bridges to Excellence
  • Integrated Healthcare Association

Insurance and Managed Care
  • Consumer Directed Health Care
  • Tricare
  • Indemnity
  • Health Maintenance Organizations (HMOs)
  • Medicare
  • Medicaid
  • Preferred Provider Organizations (PPOs), Point-of-Service (POS), Exclusive Provider Organizations (EPOs)
  • Case Management

Workers' Compensation
  • Compensability
  • Independent Medical Exams
  • Return To Work
  • Safety Programs
  • Impairment
  • Second Opinion

Clinical Resource Management
  • Utilization Review
  • Predictive Modeling / Management
  • Medicare Audits
  • Demand & Disease Management
Credentialing and Privileging
  • Core Concepts
  • National Practitioner Data Bank (NPDB)
  • Re-credentialing

Quality Improvement, Management and Assurance
  • Peer Review Organization (PRO)
  • Quality Improvement System for Managed Care (QISMC)
  • Best Practices
  • Pathways
  • Peer Review
  • Statistical Process Control
  • Continuous Quality Improvement (CQI) & Total Quality Management (TQM)
  • Theories

Case Management
  • Case Management Process
  • Guiding Principles
  • Credentialing
  • Ethical Principles
  • Informed Consent

Risk Management
  • Stark Laws
  • Anti-Kickback Statutes
  • Anti-Referral Laws
  • Safe Medical Devices
  • Patient Self Determination Act (PSDA)
  • Americans with Disabilities Act (ADA)
  • Tort Reform
  • Informed Consent
  • Patient Bill of Rights
  • Patient Safety
  • Root Cause Analysis (RCA)
  • Computerized Physician Order Entry (CPOE)

Regulatory Environment
  • Employee Retirement Income Security Act (ERISA)
  • Consolidated Omnibus Budget Reconciliation Act (COBRA)
  • Prospective Payment System (PPS)
  • Diagnosis Related Groups (DRGs)
  • Health Care Quality Improvement Act (HCQIA)
  • Health Insurance Portability and Accountability Act (HIPAA)
  • Centers for Medicare & Medicaid Services (CMS)



 
   
   
  The ABQAURP Blog ABQAURP on Twitter ABQAURP on Facebook