What are four models of HMOs? - correct answer Staff Model
Group Model
Network Model
Independent Practice Association (IPA)
What are the four types
... [Show More] of committees? - correct answer Standing
Ad hoc
Task force
Continuous quality improvement team
How many medical staff members comprise a Bylaws Committee? - correct answer 5
At least five active medical staff
How many medical staff members comprise a Credentials Committee? - correct answer 5
At least five active medical staff
How many medical staff members must serve on an Infection Control Committee? - correct answer 3
At least three active medical staff
How many medical staff members must serve on a Medical Records Committee? - correct answer 1
At least one active medical staff
How often should the Medical Records committee meet? - correct answer At least quarterly
How many medical staff members must serve on a Pharmacy & Therapeutics Committee? - correct answer 5
At least five active medical staff
How often should the Pharmacy & Therapeutics committee meet? - correct answer At least quarterly
How many medical staff members must serve on a Utilization Review Committee? - correct answer 1
At least one active medical staff
How often should the Utilization Review Committee meet? - correct answer Every other month
What is the process of obtaining, verifying, and assessing the qualifications of a health care practitioner who seeks to provide patient care services in or for a hospital? - correct answer Credentialing
What are the three reasons for credentialing? - correct answer Patient Safety
Risk Management
Required by agencies
Which three accreditors have been granted "deemed status"? - correct answer TJC, HFAP, DNV
Which two organizations offer accreditation for managed care organizations? - correct answer NCQA, URAC
Who is the main accreditor for ambulatory care facilities? - correct answer AAAHC
Physicians who are employees of a facility as hospitalists and who are not listed in the provider directory are not included in the scope of the credentialing standards with this accreditation? - correct answer URAC
For which accreditation, do the following practitioners need *not* to be credentialed including:
-exclusively in the inpatient setting caring for organization members only in the hospital setting
-practice exclusively in free-standing setting for members directed to facility
-pharmacists working for a PBM (pharmacy benefits management) organization for UM functions
-locum tenens working less than 90 days
-rental network practitioners providing out of area care - correct answer NCQA
What are Medicare CoP's minimum criteria for appointment to the medical staff/granting of medical staff privileges? - correct answer CCJET
character
competence
judgement
experience
training
CMS regulations require that medical staff bylaws include what information pertaining to each category of the medical staff? - correct answer duties and privileges
Do providers with refer and follow status have admitting privileges/ordering privileges within the hospital? - correct answer No
For TJC, does "privileges" refer to duties and prerogatives of each category or the clinical privileges to provide care? - correct answer Duties and prerogatives
Which accreditor requires an applicant to submit a statement that no health problems exist which could affect his or her ability to provide care? - correct answer TJC
Which accreditor has *no* specific requirements for professional practice [Show Less]