NAMSS CPCS Participation Guide with verified answers already passed

NAMSS CPCS Participation Guide with
verified answers already passed

- Federal/State Regulations

- CMS

- Hospital CoPs

- HCQIA

- Accreditation Standards

- TJC

- HFAP

- DNV

-Bylaws, Rules and Regs

-Standard of Care (legal aspect) - correct answer ✔✔Hospital Credentialing Driven by:



-Federal/State Regulations

-Policies and Procedures

-Accreditation Standards (NCQA, URAC)

-Standard of Care (legal aspect)

-HEDIS/CAHPS - correct answer ✔✔Managed Care Org Credentialing Driven by:



Director of Managed Care

Contracts Management --> Client Services

Financial Management --->Network Administration - correct answer ✔✔MCO Organization
Chart

, (depending on size)

Director ---> Contract sales/Credentialing Staff/Human Resources - correct answer ✔✔CVO
Organizational Chart



- Contract

- Accredidation Standards (NCQA, URAC,TJC,AAAHC, CMS, HFAP & DNV)

-Policies and Procedures - correct answer ✔✔CVO Credentialing Driven by:



- Accreditation Standards (AAAHC, TJC, NCQA)

- CMS Regulations

- State law

- Policies and Procedures

- Contractual Agreements - correct answer ✔✔Ambulatory Care/Medical Office/Surgical Center
Credentialing Driven by:



- Federal/State Regulations

- CMS

- Hospital CoPs

- HCQIA

- Accreditation Standards

- TJC

- HFAP

- DNV

-Bylaws, Rules and Regs

-Standard of Care (legal aspect) - correct answer ✔✔What is hospital credentialing driven by?



Independant CVO contracts with many outside organizations. Typically for-profit company.