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 (HEDIS®) 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)