13 CME Credits
15.6 CEU Credits

***THIS COURSE DOES NOT APPLY TO RECERTIFICATION***

This course is intended for Physicians of all specialties, Nurses, and Other Health Care Professionals with appropriate CME and CEU credit offered for each profession. This course has been produced online for your convenience. You can work from the comfort of your own home, at a time you choose. When you have successfully completed your course, you will be able to immediately print your CE certificate.

You are allotted 60 days to complete this online course. You will have the option of saving, exiting, and returning to the course as many times as you wish during the 60-day period, as long as the post-test is completed within 60 days of purchase. Once you successfully complete the post-test, you will no longer have access to the course. Please print the course modules and post-test questions prior to submitting the post-test if you wish to retain as a study guide.

In order to fulfill the education requirement for the certification examination, most examinees take advantage of the Core Body of Knowledge (CBK) Independent Study Course. While the Board recommends this course as a valuable overview of Health Care Quality and Management (HCQM), it is not required and does not ensure successful completion of the examination. Although you are allotted 60 days to complete the online course, if you intend to sit for this year's HCQM Examination, it is imperative you complete the course prior to the annual application deadline. It is recommended you complete the course by August 1 to ensure application processing time.

In recognition of dedicated service to our country, ABQAURP offers a 10% discount on the Exam fee and Core Body of Knowledge online course to all active military personnel. Please call Barbara Chalmers at (800) 998-6030, extension 116 for details and ordering.

This course is offered Online ONLY.

The key concepts of the Core Body of Knowledge (CBK) Online Course include:

• Patient Safety
• Accreditation Organizations
• Insurance and Managed Care
• Workers Compensation
• Clinical Resource Management
• Credentialing and Privileging
• Quality Improvement, Quality Management, and Quality Assurance
• Risk Management
• Regulatory Environment

Course Description & Objectives

• Identify the distinguishing characteristics of various forms of private and public health insurance and health insurance products
• Understand publicly funded health programs such as Medicare, Medicaid, Tricare, Indian Health Service
• Examine the impact of Managed Care on Quality and Utilization

Course Description & Objectives

• The states and federal Workers’ Compensation systems
• The impact of Americans With Disabilities Act (ADA) upon the injured worker
• The legal requirements an employer needs to follow when hiring a new worker
• The fairness of the “Systems” to the injured worker
• The legal aspects of the systems regulating/governing the injured/disabled worker
• What Permanent Partial Impairment (PI), Permanent Impairment (PI), Permanent Partial Disability (PPD), Permanent Disability (PD) and Temporary Total Disability (TTD) mean to the injured worker
• An Overview of Workers’ Compensation Federal Employees’ Compensation Act, Railroad, Maritime Workers, covered under Federal Employers’ Liability Act (FELA) and the Jones Act and the Obligations of ADA

Course Description & Objectives

• Explain the various ways utilization is managed and costs are controlled
• Explain the Center for Medicare and Medicaid Services (CMS, formerly the Health Care Financing Administration) efforts to identify misutilization with utilization profiles, protections for relaters and audits in both the public and private sectors
• Discuss how CMS has restored the Medicare Trust Fund through the enforcement of local and national policy
• Discuss case management components, including demand and disease management.

Course Description & Objectives

• Explain the significance of ERISA, OBRA, COBRA, TEFRA, CLIA, HIPAA, and the BBA
• Define the evolution and use of the PPS (Prospective Payment System), DRGs (Diagnosis Related Groups), APGs (Ambulatory Patient Groups), and Evaluation and Management Coding.
• Address Title XIX of the Social Security Act and the inception of Medicare along with major changes and present challenges.
• Identify the significance of the Health Care Quality Improvement Act (HCQAI) and its amendments, the National Practitioner Data Bank, and the Healthcare Integrity and Protection Data Bank.
• Illustrate how the HCQIA and its amendments have affected credentialing, de-credentialing and re-credentialing.
• Discuss major postulates established by case laws and statutes and their influence on practitioners in the health care system.

Course Description & Objectives

• Discuss the evolution and the benefits of accreditation
• Define “deeming” authority and identify the health care areas for which deemed status options are available
• Discuss the differences between accrediting organizations and regulatory agencies
• Familiarity with the purpose and goals of various accrediting bodies active in health care today
• Describe the use of The Health Plan Employer Data and Information Set (HEDIS®) in quality improvement

Course Description & Objectives

• Outline concepts essential for proper credentialing of health care providers authorized by organizations to care for patients, e.g., hospitals, ambulatory care centers, health plans, workers’ compensation provider panels
• Specify how privileges are granted, maintained and how they may be removed
• Explain the concept and importance of primary source verification
• Name the different resources that should be consulted to assure an applicant’s provision of safe care and ethical billing practices
• Explain the components necessary for periodically re-credentialing and re-privileging individuals already authorized by the organization to provide patient services
• Discuss fair hearing principles

Course Description & Objectives

• Describe the role of the PSRO (Professional Standards Review Organization), the PRO (Peer Review Organization) and the QIO (Quality Improvement Organization) in assuring quality health care
• Explore the purpose and programs of Risk Management
• Name the major theorists and explain how their theories have been applied to Quality Assurance, Quality Management, Quality Improvement, Continuous Quality Improvement and Total Quality Management
• Identify tools and processes used to determine quality of care issues and/or assure quality processes in a variety of health care environments
• Discuss the use of peer review in assuring quality of care in a variety of settings

Course Description & Objectives

• Define risk management as it relates to practitioners, managed care organizations and health care facilities.
• Peruse risk management statutes, amendments, regulations and strategies used to reduce the exposure of risk and decrease the probability of a malpractice lawsuit to both organizations and practitioners.
• Discuss tort reform and methods to effect tort reform.
• Clarify the role of governing bodies in protecting the financial assets and in reducing liabilities of health care organizations.
• Examine the purpose and principles of the Medical Staff Bylaws in reducing liability.
• Discuss the parameters of Informed Consent and the Patient Bill of Rights.
• Determine how to protect your medical license should risk management strategies fail.
• Recount the elements of a medical malpractice claim and explain the reasons why lawsuits settle.
• Examine how practitioners can determine if managed care contracts leave them vulnerable.
• Define the implications of Stark, Anti-Kickback Statute, and State Anti-Referral Restrictions
• Review the elements of an effective compliance plan.
• To understand the purpose of HIPAA legislation
• To review some of the difficulties in HIPAA compliance.
• To review the penalties for non-compliance with HIPAA
• To consider the impact of HIPAA regulations on medical practice.

Course Description & Objectives

• Review the Institute Of Medicine’s report “To Err is Human” and its impact on Patient Safety
• Explore the many causes of medical error
• Explore Computer Physician Order Entry (CPOE) Systems
• Review the Leapfrog Group purchasers’ initial methods to improve patient safety
• Review The Leapfrog Group's CPOE Patient Safety Standard