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

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

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

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)