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| certified provider credentialing specialist training: Certified Provider Credentialing Specialist National Learning Corporation, 2019 The Certified Provider Credentialing Specialist Passbook(R) prepares you by sharpening the skills and abilities necessary to succeed on your upcoming entrance exam. |
| certified provider credentialing specialist training: CPHIMS Review Guide Himss, 2016-07-27 Whether you're taking the CPHIMS exam, or simply want the most current and comprehensive overview in healthcare information and management systems today - this completely revised and updated third edition has it all. But for those preparing for the CPHIMS exam, this book is an ideal study partner. The content reflects the exam content outline covering healthcare and technology environments; systems analysis, design, selection, implementation, support, maintenance, testing, evaluation, privacy and security; and administration leadership management. Candidates can challenge themselves with the sample multiple choice questions at the end of the book. |
| certified provider credentialing specialist training: Medical Quality Management Angelo P. Giardino, Lee Ann Riesenberg, Prathibha Varkey, 2020-08-31 This comprehensive medical textbook is a compendium of the latest information on healthcare quality. The text provides knowledge about the theory and practical applications for each of the core areas that comprise the field of medical quality management as well as insight and essential briefings on the impact of new healthcare technologies and innovations on medical quality and improvement. The third edition provides significant new content related to medical quality management and quality improvement, a user-friendly format, case studies, and updated learning objectives. This textbook also serves as source material for the American Board of Medical Quality in the development of its core curriculum and certification examinations. Each chapter is designed for a review of the essential background, precepts, and exemplary practices within the topical area: Basics of Quality Improvement Data Analytics for the Improvement of Healthcare Quality Utilization Management, Case Management, and Care Coordination Economics and Finance in Medical Quality Management External Quality Improvement — Accreditation, Certification, and Education The Interface Between Quality Improvement and Law Ethics and Quality Improvement With the new edition of Medical Quality Management: Theory and Practice, the American College of Medical Quality presents the experience and expertise of its contributors to provide the background necessary for healthcare professionals to assume the responsibilities of medical quality management in healthcare institutions, provide physicians in all medical specialties with a core body of knowledge related to medical quality management, and serve as a necessary guide for healthcare administrators and executives, academics, directors, medical and nursing students and residents, and physicians and other health practitioners. |
| certified provider credentialing specialist training: Certified Provider Credentialing Specialist (CPCS) , 2024-05 The Certified Provider Credentialing Specialist Passbook(R) prepares you by sharpening the skills and abilities necessary to succeed on your upcoming entrance exam. |
| certified provider credentialing specialist training: Practice Management Reference Guide - First Edition AAPC, 2020-03-16 Effectively manage the business side of medicine. Profit margin, collections, cash flow, compliance, human resources, health information, efficient business processes—the broad responsibilities and complex requirements of practice management are endless. Drop one ball in the daily juggle and the fallout can be costly. There’s never enough time, which makes it tough to stay on top of regulations and best practices. That’s where AAPC’s Practice Management Reference Guide becomes vital to your organization, providing you with one-stop access to the latest and best in practice management. From office operations to financial oversight, the Practice Management Reference Guide lays out essential guidance to help you optimize efficiency, security, and profitability. Benefit from actionable steps to streamline accounts receivable. Discover how to bring in new patients and keep the ones you have happy. Leverage real-world strategies to command payer relations, recruitment, training, employee evaluations, HIPAA, MACRA, Medicare, CDI, EHR … everything you need to ensure bountiful operations in 2020 and beyond. With the Practice Management Reference Guide, you’ll gain working knowledge covering the spectrum of practice management issues, including: Negotiating favorable payer contracts Preventing an appeals backlog Remaining audit-ready Correctly applying incident-to billing rules to maximize reimbursement Using assessment tools to evaluate your risk Preparing a risk plan and know what questions to ask Knowing how and why you should implement policies and protocols Complying with state and federal patient privacy rules |
| certified provider credentialing specialist training: Denials Management & Appeals Reference Guide - First Edition AAPC, 2020-03-17 Recoup lost time and revenue with denials management and appeals know-how. Claim denials can sink a profit margin. And given the cost of appeals, roughly $118 per claim, not all denials can be reworked. A practice submitting 50 claims a day at an average reimbursement rate of $200 per claim should bring in $10,000 in daily revenue. But if 10% of those claims are denied, and the practice can only appeal one, they lose $800 per day—upwards of $200K annually. Your medical claims are the lifeblood of operations. Don’t compromise your financial health. Learn how to preempt denials with the Denials Management & Appeals Reference Guide. This vital resource will equip you to get ahead of payers by simplifying the leading causes of denials and showing you how to address insufficient documentation, failing to establish medical necessity, coding and billing errors, coverage stipulations, and untimely filing. Rely on AAPC to walk you through the appeal process. We’ll help you establish protocols to avoid an appeals backlog and teach you how to identify and prioritize denials likely to win an appeal. What’s more, you’ll learn when a claim can be “reopened” to fix a problem. Collect the revenue your practice deserves with effective denials and appeals solutions: Know how to analyze your denials Defeat documentation and compliance issues for successful claims success Utilize payer policy for coverage clues Lock in revenue with face-to-face reimbursement guidance Refine efforts to avoid E/M claim denials Ace ICD-10 coding for optimum reimbursement Put an end to modifier confusion Stave off denials with CCI edits advice Navigate the appeals process like a pro And much more! |
| certified provider credentialing specialist training: The Credentialing Coordinator's Handbook Anne Roberts, 2007 |
| certified provider credentialing specialist training: The Handbook for Credentialing Healthcare Providers Ellis Knight, 2016-04 This handbook enables your organization to systemize the tedious, ongoing, and mandatory process of credentialing your medical staff and to understand why you must! Healthcare organizations must have credentialed medical staffs to deliver their services. The reasons are two-fold: First, educated, licensed, experienced, and proven caregivers ensure that a hospital or medical practice is capable of delivering quality care. Secondly, payers require that the physicians and other licensed healthcare professionals are qualified and licensed to work with their patients. Before receiving payment for services, the provider must have specific credentials for providing that service. Verifying and documenting the credentials of a healthcare provider is tedious, ongoing, and mandatory. An organization with a large medical staff may struggle with keeping the credentialing function current, as many licenses have rolling expirations. Credentialing ensures that clinical practitioners are duly qualified, licensed, and board certified. It reports the history of malpractice claims, state-instituted sanctions, or other undesirable professional circumstances of providers. Credentialing and privileging of healthcare professionals protects patients and hospitals by minimizing the risk of medical errors that may result from the work of incompetent providers. It also undergirds the reputation and credibility of the institution in the eyes of providers and across the healthcare community. Further, credentialing with insurers forms the basis for reimbursement for professional services. Without the acceptance of the professional credentials of a provider, insurers and other third-party payers will not compensate his or her claims. The purpose of this book is to explain the necessity and to provide the process for the official documentation of each practitioner. The information presented in these chapters will serve as a practical resource for strengthening your organization's credentialing function. = Book Features! -Outlines the necessity for credentialing in the delivery of care and in attaining reimbursements for services provided -Explores options for in-house and outsourced credentialing function -Provides systematic process for ongoing credentialing operations |
| certified provider credentialing specialist training: Health Professions Education Institute of Medicine, Board on Health Care Services, Committee on the Health Professions Education Summit, 2003-07-01 The Institute of Medicine study Crossing the Quality Chasm (2001) recommended that an interdisciplinary summit be held to further reform of health professions education in order to enhance quality and patient safety. Health Professions Education: A Bridge to Quality is the follow up to that summit, held in June 2002, where 150 participants across disciplines and occupations developed ideas about how to integrate a core set of competencies into health professions education. These core competencies include patient-centered care, interdisciplinary teams, evidence-based practice, quality improvement, and informatics. This book recommends a mix of approaches to health education improvement, including those related to oversight processes, the training environment, research, public reporting, and leadership. Educators, administrators, and health professionals can use this book to help achieve an approach to education that better prepares clinicians to meet both the needs of patients and the requirements of a changing health care system. |
| certified provider credentialing specialist training: ACSM's Clinical Exercise Physiology American College of Sports Medicine, 2019-02-01 ACSM’s Clinical Exercise Physiology adapts and expands upon the disease-related content from ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription, 7th Edition, to create a true classroom textbook. This new resource offers research-based coverage of more than 35 conditions commonly seen in practice—from a host of cardiovascular disorders to immunological/hematological disorders. Condition chapters are organized by disease types and then divided into sections that cover specific conditions from a pathological and etiological perspective. To provide a complete view of clinical exercise physiology, the book also covers important considerations and foundational elements, such as screening, pharmacology, and electrocardiography. As an American College of Sports Medicine publication, the text offers the unsurpassed quality and excellence that has become synonymous with titles by the leading exercise science organization in the world. |
| certified provider credentialing specialist training: Registered Health Information Administrator (RHIA) Patricia Shaw, Darcy Carter, Heather Merkley, 2010-01-01 |
| certified provider credentialing specialist training: The ASQ Certified Quality Improvement Associate Handbook Grace L. Duffy, 2020-03-01 The ASQ Certified Quality Improvement Associate (CQIA) certification introduces the basics of quality to organizations and individuals who are new to quality. This book, and the Body of Knowledge (BoK) it supports, form a foundation for applying proven quality principles and practices that are used around the world. This handbook follows the CQIA span in both content and sequence. Let it serve as your guide in preparing for the ASQ CQIA examination, and refer to it frequently as you learn and implement these ideas and tools in your organization. |
| certified provider credentialing specialist training: Cphq Study Guide 2020 and 2021 - Chpq Exam Secrets Study Guide, Full-Length Practice Exam, Detailed Answer Explanations Mometrix Test Prep, 2020-07-28 Mometrix Test Preparation's CPHQ Study Guide 2020 and 2021 - CHPQ Exam Secrets Study Guide is the ideal prep solution for anyone who wants to pass their Certified Professional in Healthcare Quality Exam. The exam is extremely challenging, and thorough test preparation is essential for success. Our study guide includes: * Practice test questions with detailed answer explanations * Tips and strategies to help you get your best test performance * A complete review of all CPHQ test sections * Management and Leadership * Information Management * Performance Measurement and Improvement * Patient Safety Mometrix Test Preparation is not affiliated with or endorsed by any official testing organization. All organizational and test names are trademarks of their respective owners. The Mometrix guide is filled with the critical information you will need in order to do well on your CPHQ exam: the concepts, procedures, principles, and vocabulary that the Healthcare Quality Certification Board (HQCB) expects you to have mastered before sitting for your exam. The Management and Leadership section covers: * Certified Professional in Healthcare Quality * Leadership values * Organizational culture * Voluntary accreditation processes * Facilitating change within the healthcare system The Information Management section covers: * Design and Data Collection * Measurement * Analysis * Communication The Performance Measurement and Improvement section covers: * Planning * Implementation * Education and Training * Evaluation and Integration The Patient Safety section covers: * Integrating patient safety concepts * Written hospital safety plans * Patient safety technology * Integrating safety into organizational activities * Risk management ...and much more! Our guide is full of specific and detailed information that will be key to passing your exam. Concepts and principles aren't simply named or described in passing, but are explained in detail. The Mometrix CPHQ study guide is laid out in a logical and organized fashion so that one section naturally flows from the one preceding it. Because it's written with an eye for both technical accuracy and accessibility, you will not have to worry about getting lost in dense academic language. Any test prep guide is only as good as its practice questions and answer explanations, and that's another area where our guide stands out. The Mometrix test prep team has provided plenty of CPHQ practice test questions to prepare you for what to expect on the actual exam. Each answer is explained in depth, in order to make the principles and reasoning behind it crystal clear. We've helped hundreds of thousands of people pass standardized tests and achieve their education and career goals. We've done this by setting high standards for Mometrix Test Preparation guides, and our CPHQ Study Guide 2020 and 2021 - CHPQ Exam Secrets Study Guide is no exception. It's an excellent investment in your future. Get the CPHQ review you need to be successful on your exam. |
| certified provider credentialing specialist training: ACSM's Resources for the Personal Trainer American College of Sports Medicine, 2013-03-22 ACSM’s Resources for the Personal Trainer provides a broad introduction to the field of personal training, covering both basic science topics and practical application. It was originally designed to help people prepare for the ACSM Personal Training Certification Exam. It continues to serve that function, but the market for it has expanded to practitioners in the field looking for an additional resource, as well as in an academic setting where the book is a core text for personal training programs. |
| certified provider credentialing specialist training: Credentialing, Privileging, and Medical Staff Governance Sheri Patterson, 2018 |
| certified provider credentialing specialist training: Managed Care Credentialing Amy N. Niehaus, 2019 The role of the MSP is expanding to include payer enrollment and delegated credentialing responsibilities for managed care organizations. Traditionally siloed, MSPs are now beginning to take on both responsibilities, which means they must learn the nuances of managed care credentialing as well as the regulatory and accreditation requirements of NCQA, CMS, and URAC. Managed Care Credentialing: Compliance Strategies for Health Plans, CVOs, and Delegated Entities provides the answers to MSPs' inevitable questions as they begin to manage the tasks of payer enrollment and delegated credentialing. Author Amy M. Niehaus guides readers through each payer's requirements, the differences between hospital and managed care credentialing, and how to help their organization establish delegated credentialing agreements and prepare for audits. As new and existing MSP responsibilities begin to collide, this resource also outlines ways MSPs can modify their current processes to reduce duplication of efforts and develop a comprehensive and compliant managed care credentialing program. Whether you are new to managed care credentialing or are taking on delegated credentialing responsibilities, this book will help you: Learn the regulatory and accreditation requirements related to managed care credentialing Streamline the provider enrollment process through delegation Meet your organizational goals of compliance, operational efficiency, cost savings, and practitioner satisfaction Identify the differences between hospital and managed care credentialing |
| certified provider credentialing specialist training: The Credentialing Handbook Sheryl Deutsch, Sheryl K. Deutsch, Christine S. Mobley, 1999 The Credentialing Handbook provides comprehensive, plain-English guida nce to understand and master the provider credentialing process in any health care setting. With sample forms, checklists, flowcharts, and c orrespondence, this practical guide walks you through every aspect of effective credentialing, appointment, and recredentialing. You'll lear n: key steps in the credentialing process; about express credentialin g models; how to credential allied health practitioners; typical time frames and tracking systems; pros and cons of delegating credentialin g, plus more. |
| certified provider credentialing specialist training: Guide to Physical Therapist Practice American Physical Therapy Association (1921- ), 2001-01-01 This text guides patterns of practice; improves quality of care; promotes appropriate use of health care services; and explains physical therapist practice to insurers, policymakers, and other health care professionals. This edition continues to be a resource for both daily practice and professional education. |
| certified provider credentialing specialist training: ACSM's Certification Review American College of Sports Medicine, 2010 This is a review manual for candidates wanting an ACSM credential. It combines content from 'ACSM's Health and Fitness Certification Review' and 'ACSM's Clinical Certification Review' into one resource. |
| certified provider credentialing specialist training: The ASQ Certified Manager of Quality/Organizational Excellence Handbook Sandra L Furterer, Douglas C Wood, 2021-01-25 This handbook is a comprehensive reference designed to help professionals address organizational issues from the application of the basic principles of management to the development of strategies needed to deal with today’s technological and societal concerns. The fifth edition of the ASQ Certified Manager of Quality/Organizational Excellence Handbook (CMQ/OE) has undergone some significant content changes in order to provide more clarity regarding the items in the body of knowledge (BoK). Examples have been updated to reflect more current perspectives, and new topics introduced in the most recent BoK are included as well. This handbook addresses: • Historical perspectives relating to the continued improvement of specific aspects of quality management • Key principles, concepts, and terminology • Benefits associated with the application of key concepts and quality management principles • Best practices describing recognized approaches for good quality management • Barriers to success, common problems you may encounter, and reasons why some quality initiatives fail • Guidance for preparation to take the CMQ/OE examination A well-organized reference, this handbook will certainly help individuals prepare for the ASQ CMQ/OE exam. It also serves as a practical, day-to-day guide for any professional facing various quality management challenges. |
| certified provider credentialing specialist training: National Telemetry Association Nancy Kimmel, 2009-10-09 Review basic principles on the reading and interpreting cardiac rhythms |
| certified provider credentialing specialist training: CHES Exam Secrets Study Guide Ches Exam Secrets Test Prep, 2018-04-12 ***Includes Practice Test Questions*** CHES Exam Secrets helps you ace the Certified Health Education Specialist Exam, without weeks and months of endless studying. Our comprehensive CHES Exam Secrets study guide is written by our exam experts, who painstakingly researched every topic and concept that you need to know to ace your test. Our original research reveals specific weaknesses that you can exploit to increase your exam score more than you've ever imagined. CHES Exam Secrets includes: The 5 Secret Keys to CHES Exam Success: Time is Your Greatest Enemy, Guessing is Not Guesswork, Practice Smarter, Not Harder, Prepare, Don't Procrastinate, Test Yourself; A comprehensive General Strategy review including: Make Predictions, Answer the Question, Benchmark, Valid Information, Avoid Fact Traps, Milk the Question, The Trap of Familiarity, Eliminate Answers, Tough Questions, Brainstorm, Read Carefully, Face Value, Prefixes, Hedge Phrases, Switchback Words, New Information, Time Management, Contextual Clues, Don't Panic, Pace Yourself, Answer Selection, Check Your Work, Beware of Directly Quoted Answers, Slang, Extreme Statements, Answer Choice Families; A comprehensive Responsibility I review including: Community Analysis, Community Diagnosis, Needs Assessment, Primary Data, Secondary Data, Mail Survey, Telephone Survey, In-person Survey, Interviews, Focus Groups, Nominal Group Process, Delphi Panels, Observation, Health Risk Appraisals/Assessments (HRA); A comprehensive Responsibility II review including: Mission Statement, Outcome Objective, Goals, Behavioral Objective, PRECEDE-PROCEED, MATCH, Impact Objective, PATCH, Healthy People 2010, Health Education, Objectives, SMART; A comprehensive Responsibility III review including: Learning Activities, Implementation, Primary Function, Five Phases of Implementation, Pre-testing, Four Ps of Marketing, Educational Activities, Environmental Interventions, Behavior Modification, and much more... |
| certified provider credentialing specialist training: Verify and Comply Carol S. Cairns, 2009-11 Verify and Comply: A Quick Reference Guide to Credentialing Standards, Fifth Edition Carol S. Cairns, CPMSM, CPCS The Joint Commission... NCQA... CMS... DNV... HFAP... Searchable and side-by-side! Verify and Comply, Fifth Edition, is the much anticipated next edition of one of HCPro's most popular credentialing resources. Many satisfied customers have used this resource to study for their NAMSS certification exams and to keep up to date with accreditors' credentialing standards. This newly expanded guide addresses Joint Commission, NCQA, and CMS standards in the book, as well as DNV and HFAP on the companion CD-ROM. That means five sets of accreditors' standards are side-by-side and searchable by topic on CD-ROM. Get the resource thousands of MSPs have come to rely on. It will help you: Easily access, navigate, and compare the requirements of all five organizations at a glance Eliminate wasted time searching through multiple resources to find what you need Stop struggling to interpret the standards on your own Understand the differences between the stages of the credentialing process--appointment, reappointment, and ongoing assessment Get answers to your credentialing questions quickly and easily Study for your CPCS and CPMSM certification exams No other resource for credentialing standards offers you this level of expertise and convenience. All five sets of standards side-by-side, organized by topic, on a searchable CD-ROM The Joint Commission NCQA CMS DNV HFAP Three sets of standards in print in the book (The Joint Commission, NCQA, and CMS) Straightforward, complete summaries of standards Expert interpretation of the standards Distinct sections that clarify the differences between each stage of the credentialing process A tips section that allows for further analysis Special notations to readers who are studying for the CPMSM/CPCS exams Who will benefit? Credentialing specialist/analyst Medical staff services coordinator Director of medical staff services Credentialing coordinator Credentialing manager Medical staff professional Survey coordinator Earn continuing education credits! This program has been approved by the National Association Medical Staff Services for up to 3.0 continuing education unit(s). Accreditation of this educational program in no way implies endorsement or sponsorship by NAMSS. Navigate credentialing standards faster and easier. Order your copy today. |
| certified provider credentialing specialist training: Cancer Registry Management Herman R. Menck, 2011 |
| certified provider credentialing specialist training: The Basics of Achieving Professional Certification Willis H. Thomas, 2017-07-27 Professional certification has become a very popular topic and a significant number of individuals are making it a priority. Some people are torn on whether or not to obtain a certification to bolster their career. Others see the advantage of diversifying their professional portfolio and pursuing popular certifications in the areas of Project Management, Information Technology, Quality, or Human Resources. The Basics of Achieving Professional Certification: Enhancing Your Credentials provides clear-cut guidance on how to select a certification that is right for you and how you can continue to build your credentials in support of personal and professional goals. This easy-to-use guide can help anyone looking to achieve professional certification make informed decisions about the many options available. It can also help avoid the pitfalls of making the wrong choice as a result of being incorrectly informed. Examining the range of professional certifications offered by associations and organizations, it explains how to select the right professional certification and outlines best practices for completing the certification process. The book includes a CD that represents more than a year of development between resources in the U.S. and Europe. Packed with tools, it supplies permanent access to a suite of helpful training and development software, including:Library management system to track training material, books, and related items (created in MS Access)Learning management system to ensure training compliance (created in MS Access)A number of project management resources, including a comprehensive exam preparation programRoyalty free multimedia resources to add pizzazz to your e-learning programsForms, templates, and checklists to support training administrationTool |
| certified provider credentialing specialist training: CPT Professional 2022 American Medical Association, 2021-09-17 CPT(R) 2022 Professional Edition is the definitive AMA-authored resource to help healthcare professionals correctly report and bill medical procedures and services. |
| certified provider credentialing specialist training: Inpatient Obstetric Nursing National Learning Corporation, 2017 The Certified Nurse Examination Series prepares individuals for licensing and certification conducted by the American Nurses Credentialing Center (ANCC), the National Certification Corporation (NCC), the National League for Nursing (NLN), and other organizations. |
| certified provider credentialing specialist training: 2022 Hospital Compliance Assessment Workbook Joint Commission Resources, 2021-12-30 |
| certified provider credentialing specialist training: Physician Credentialing Veronica L. Rosas, 2015-07-20 Physician Credentialing: A Guide for Physician Office Staff Veronica L. Rosas, CPCS Credentialing providers in a physician practice is a confusing and time-consuming process that can seem daunting to even the most seasoned professional. Between managing the credentialing of new physicians to the mandatory recredentialing that must be undertaken every few years, it is imperative that practice-based credentialing coordinators are on top of their game. Covering the credentialing process for both hospitals and managed care organizations, Physician Credentialing: A Guide for Physician Office Staff is a must-have, practical, and easy-to-read guide for credentialing coordinators and office managers, whether they are brand-new or experienced. The book walks readers through the required forms, provides suggested timelines, details documentation requirements, and offers tips for multitasking and organizational strategies to maximize efficiency. There is even helpful professional guidance, including information on certification, networking, and education. This resource will help you do the following: Utilize your time efficiently by knowing all the steps in the credentialing process Stay on top of credentialing in the physician practice Plan ahead to manage credentialing for new physicians while maintaining credentials for current providers Table of Contents Preface Part 1: Introduction Chapter 1: Introduction to Credentialing Chapter 2: The Credentialing Application Chapter 3: The Managed Care Credentialing Process Chapter 4: The Hospital Credentialing Process Part 2: Introduction Chapter 5: Credentialing the New Provider Chapter 6: Recredentialing and Reappointment Chapter 7: Managed Care Organization Contracts Chapter 8: Multitasking Chapter 9: Not All Healthcare Organizations Are the Same Chapter 10: On Your Own but Not Alone: Networking, Education, and Certification Conclusion Appendixes Appendix A: Contracting Checklist Appendix B: Acronym List Who should read this book? Credentialing coordinator Credentialing professionals Physician practice manager Physician office manager Physician practice administrator Practice manager Office manager Practice administrator Business manager |
| certified provider credentialing specialist training: Nursing Professional Development Review Manual, 3rd Edition Beth Hawkes, Ellen Gorbunoff, Laura Hendricks-Jackson, Patricia Kummeth, 2014-07 |
| certified provider credentialing specialist training: Pediatric Nursing National Association of Pediatric Nurse Practitioners, American Nurses Association, 2008 Although this reference and guide is mainly for practicing nurses and nursing faculty and students, Pediatric Nursing: Scope and Standards of Practice is also an essential source document for other pediatric specialists, healthcare providers, researchers, and scholars. As well, it will help such stakeholders as administrators, educators, and policy makers invested in healthcare access, delivery, evaluation, and financing in any pediatric setting. |
| certified provider credentialing specialist training: Credentialing for Managed Care Amy M. Niehaus, 2016-08-17 Credentialing for Managed Care: Compliant Processes for Health Plan and Delegated Entities Amy M. Niehaus, CPMSM, CPCS, MBA New to managed care credentialing? Whether you work for a health plan or a hospital medical staff services department, this how-to guide answers all of your health plan credentialing and enrollment questions. Learn the regulatory and accreditation requirements related to managed care credentialing, including those from CMS, NCQA, and URAC. Author Amy M. Niehaus, CPMSM, CPCS, MBA, provides readers with the guidance to create a comprehensive and compliant credentialing program to support your health plan or to streamline your hospital's provider enrollment process through delegation. MSPs in all healthcare environments can benefit from understanding credentialing in the managed care world to support their organizational goals of compliance, operational efficiency, cost savings, and practitioner satisfaction. This book will help you: - Understand NCQA, URAC, and CMS requirements for health plans - Develop a comprehensive and compliant managed care credentialing program - Establish delegated credentialing agreements - Audit credentials files - Recognize how payer credentialing requirements impact other healthcare organizations - Streamline provider enrollment through delegation - Identify the differences between hospital and managed care credentialing - Evaluate whether a credentials verification organization is right for your organization About the author: Amy M. Niehaus, CPMSM, CPCS, MBA, is a consultant with The Greeley Company, an industry-leading healthcare consulting firm. She has over 25 years' experience in the medical services and credentialing profession. In her current role, she advises clients in the areas of accreditation, regulatory compliance, credentialing, process simplification and redesign, credentialing technology, and credentials verification organizations (CVO) development and delegation. Niehaus has worked in multiple environments throughout her career, including acute care hospitals, CVOs, and managed care organizations (MCO). She has been a member of the National Association Medical Staff Services (NAMSS) since 1991 and achieved her CPMSM certification in 1992 and her CPCS certification in 2002. Niehaus is a NAMSS instructor and previously served as chair of its MCO Task Force, as well as chair and member of the NAMSS Education Committee. She is a former president of the Missouri Association Medical Staff Services and its greater St. Louis area chapter. Niehaus holds a bachelor's degree from the University of Missouri and a master's degree in business administration from Maryville University in St. Louis. Niehaus has developed and presented various programs to local and national audiences on topics such as credentialing and privileging processes; Joint Commission, National Committee for Quality Assurance (NCQA), and URAC accreditation standards; and delegation. |
| certified provider credentialing specialist training: Certified Professional in Medical Services Management National Learning Corporation, 2019 The Certified Professional in Medical Services Management (CPMSM) Passbook(R) prepares you by sharpening the skills and abilities necessary to succeed on your upcoming entrance exam. |
| certified provider credentialing specialist training: Psychiatric-Mental Health Nursing American Nurses Association, 2014-05-14 |
| certified provider credentialing specialist training: The Oxford Handbook of Education and Training in Professional Psychology W. Brad Johnson, Nadine J. Kaslow, 2014 This title provides a comprehensive treatment of the processes and current state-of-the art practices bearing on educating and training professional psychologists. The handbook covers the full spectrum of historic developments, salient issues, current standards, and emerging trends in psychology education and training. |
| certified provider credentialing specialist training: CRES Exam Secrets Study Guide Cres Exam Secrets Test Prep, 2018-04-12 CRES Exam Secrets helps you ace the Certified Radiology Equipment Specialist Examination, without weeks and months of endless studying. Our comprehensive CRES Exam Secrets study guide is written by our exam experts, who painstakingly researched every topic and concept that you need to know to ace your test. Our original research reveals specific weaknesses that you can exploit to increase your exam score more than you've ever imagined. CRES Exam Secrets includes: The 5 Secret Keys to CRES Exam Success: Time is Your Greatest Enemy, Guessing is Not Guesswork, Practice Smarter, Not Harder, Prepare, Don't Procrastinate, Test Yourself; A comprehensive General Strategy review including: Make Predictions, Answer the Question, Benchmark, Valid Information, Avoid Fact Traps, Milk the Question, The Trap of Familiarity, Eliminate Answers, Tough Questions, Brainstorm, Read Carefully, Face Value, Prefixes, Hedge Phrases, Switchback Words, New Information, Time Management, Contextual Clues, Don't Panic, Pace Yourself, Answer Selection, Check Your Work, Beware of Directly Quoted Answers, Slang, Extreme Statements, Answer Choice Families; A comprehensive Content review including: Anatomy Of A Cell, Nervous System, Photon, Electron-Binding Energy, Cardiovascular System, Pulmonary Artery, Beam Filtration, Milliamperes, Diastolic Pressure, Atrioventricular Node, Electrostatic Charges, Parallel Circuit, Proximal, Dorsal Recumbent, Spinal Topography, Ventral Decubitus, Mammogram Imaging System, Topographical Lines, Body Habitus, Appendicular Divisions, Vertebral Column, Synovial Joints, Heterogeneous Beam, Ionizing Radiation, Compton's Interaction, ALARA, Disposing Of Hazardous Materials, Atomic Nucleus, Electromagnetic Energy, Isotopes, Octet Rule, Gamma Rays, Laws Of Electrostatics, Electrodynamics, Electric Resistance, Ohm's Law, Magnetic Field, Autotransformer, Logarithmic Numbering Systems, Concept Of Half-Life, X-Ray Image, Photoelectric Effect, and much more... |
| certified provider credentialing specialist training: CRISC Review Manual 6th Edition Isaca, 2016 |
| certified provider credentialing specialist training: Nursing Informatics American Nurses Association, 2015 The second edition of Nursing Informatics: Scope and Standards of Practice is the most comprehensive, up-to-date resource available in this subject area. The book covers the full scope of nursing informatics and outlines the competency level of nursing practice and professional performance expected from all informatics nurses and nurse specialists. In addition, it details the nursing informatics competencies needed by any RN, spans all nursing careers and roles, and reflects the impact of informatics in any health care practice environment. This is a must-read for nurses, as informatics touche. |
| certified provider credentialing specialist training: Slee's Health Care Terms Vergil N. Slee, Debora A. Slee, Herbert Joachim Schmidt, 2001 Includes terms from: health care administration, public health & epidemiology, government regulation, ethics & patient empowerment, finance & reimbursement, medical staff organization, clinical medicine & nursing, science, research & technology, law & legislation, and healthy communities movement. |
| certified provider credentialing specialist training: CMC Exam Secrets Study Guide: CMC Test Review for Cardiac Medicine Certification Exam CMC Exam Secrets Test Prep Team, 2013-02 ***Includes Practice Test Questions*** CMC Exam Secrets helps you ace the Cardiac Medicine Certification Exam without weeks and months of endless studying. Our comprehensive CMC Exam Secrets study guide is written by our exam experts, who painstakingly researched every topic and concept that you need to know to ace your test. Our original research reveals specific weaknesses that you can exploit to increase your exam score more than you've ever imagined. CMC Exam Secrets includes: The 5 Secret Keys to CMC Exam Success: Time is Your Greatest Enemy, Guessing is Not Guesswork, Practice Smarter, Not Harder, Prepare, Don't Procrastinate, Test Yourself; A comprehensive General Strategy review including: Make Predictions, Answer the Question, Benchmark, Valid Information, Avoid Fact Traps, Milk the Question, The Trap of Familiarity, Eliminate Answers, Tough Questions, Brainstorm, Read Carefully, Face Value, Prefixes, Hedge Phrases, Switchback Words, New Information, Time Management, Contextual Clues, Don't Panic, Pace Yourself, Answer Selection, Check Your Work, Beware of Directly Quoted Answers, Slang, Extreme Statements, Answer Choice Families; A comprehensive Content review including: Acute Coronary Syndrome, STEMI, Beta-Blockers, Morphine Sulfate, Normal Sinus Rhythm, Ventricular Tachycardia, Torsades De Pointes, Sinus Bradycardia, Supraventricular Tachycardia, Wolff-Parkinson-White Syndrome, Wenckebach AV Block, Papillary Muscle Rupture, Ventricular Aneurysmectomy, Pulmonary Edema, Dilated Cardiomyopathy, Mitral Valve Regurgitation, Aortic Stenosis, Cardiac Tamponade, Pericardiocentesis, Cardiogenic Shock, Myocarditis, Pericarditis, Venous Thrombosis, Hypertension, 'White Coat' Hypertension, Tetralogy Of Fallot, Truncus Arteriosus, Ebstein's Anomaly, Acute Pulmonary Embolus, Acute Respiratory Distress Syndrome, Cor Pulmonale, Pneumothorax, Pneumomediastinum, Diabetes Mellitus, Hemoglobin A1C Test, Ischemic Stroke, and much more... |
Certified Payments
Apr 25, 2015 · Certified Payments provides payment services to government agencies across the United States.
Certified Payments
Certified Payments provides a service for consumers and businesses to make payments via their credit card for various types of services and taxes. By utilizing Certified Payments, you, the …
Certified Payments - Timeout
Certified Payments provides payment services to government agencies across the United States.
Certified Payments - Sign On
Nov 24, 2013 · Welcome to Certified Payments Reporting Services. Username Password. Access Code Forgot Password
Certified Payments
Certified Payments will be retiring the use of Transport Layer Security (TLS) 1.0 July 31, 2018, following the requirements of the PCI Security Standards Council (PCI SSC) due to several …
Certified Payments - Payment Wizard - Step 1
Certified Payments provides payment services to government agencies across the United States.
Certified Payments - Consumer Payment Lookup
Certified Payments provides payment services to government agencies across the United States.
Certified Payments - Forgot Password
Nov 24, 2013 · Certified Payments - Forgot Password Username Access Code Copyright © 2025. Licensed by Certified Payments, a division of Accelerated Card Company, LLC.
Certified Payments - Timeout Notice
Apr 25, 2015 · For security reasons, the Certified Payments system, automatically terminates any session after it has been left inactive for longer than 10 minutes. Certified Payments does this to …
certifiedpayments.net
Certified Payments provides payment services for consumers and businesses to make payments via credit card for various services and taxes.
Certified Payments
Apr 25, 2015 · Certified Payments provides payment services to government agencies across the United States.
Certified Payments
Certified Payments provides a service for consumers and businesses to make payments via their credit card for various types of services and taxes. By utilizing Certified Payments, you, the …
Certified Payments - Timeout
Certified Payments provides payment services to government agencies across the United States.
Certified Payments - Sign On
Nov 24, 2013 · Welcome to Certified Payments Reporting Services. Username Password. Access Code Forgot Password
Certified Payments
Certified Payments will be retiring the use of Transport Layer Security (TLS) 1.0 July 31, 2018, following the requirements of the PCI Security Standards Council (PCI SSC) due to several …
Certified Payments - Payment Wizard - Step 1
Certified Payments provides payment services to government agencies across the United States.
Certified Payments - Consumer Payment Lookup
Certified Payments provides payment services to government agencies across the United States.
Certified Payments - Forgot Password
Nov 24, 2013 · Certified Payments - Forgot Password Username Access Code Copyright © 2025. Licensed by Certified Payments, a division of Accelerated Card Company, LLC.
Certified Payments - Timeout Notice
Apr 25, 2015 · For security reasons, the Certified Payments system, automatically terminates any session after it has been left inactive for longer than 10 minutes. Certified Payments does this …
certifiedpayments.net
Certified Payments provides payment services for consumers and businesses to make payments via credit card for various services and taxes.
