NAMSS Certification – Flashcards
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AHRQ - Agency for Healthcare Research and Qualtiy
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An agency within DHHS established in 1989 to improve quality, appropriateness and effectiveness of US Healthcare
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AHRQ
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Agency for Healthcare Research and Qualtiy 1989
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Medicare Program
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Established by an amendment to the Social Security Act in 1965
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SMDA
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Safe Medical Device Act of 1990
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HCQIA
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Provides immunity from liability for damages from good-faith peer review
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Title 42
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The Public Health and Welfare
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Conditions of Participation
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Federal regulations relating to Medicare and Medicaid
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The Federal Register
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Contains details of proposed and recently passed federal regulations and Presidential executive orders
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Boyd v Albert Einstein
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Doctrine of Ostensible Agency - HMO found liable in patient's death. Chest perforation during breast biopsy, chest pain/MI six weeks later.
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Elam v CollegePark
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Doctrine of Corporate Negligence - Med Records had information on many lawsuits agains podiatrist
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Patrick v Burget
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Anticompetitive Peer Review - Led to development of HCQIA
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Gonzales v Nork & Mercy Hospital
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Hospitals owe patients a duty of care - laminectomy, negligently performed. MD had history of unnecessary or negligent surgeries
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Webman v Little Company of Mary
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Duty to credential - application denied when physician refused to authorize prior hospital to release information.
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Mahmoodian v United
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Disruptive behavior - hospital can revoke otherwise competent physician's privileges when disruptive behavior adversely affects patient care.
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Darling v Charleston
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End of Doctrine of charitable immunity - Patient lost leg due to improper casting. Hospitals are independently responsible for monitoring and supervising care provided.
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Mathews v Lancaster
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HCQIA - Burden on physician to prove bad faith peer review. Committee including competitors found sub-standard care by Surgeon
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Bell v Sharp
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Negligent Credentialing - Hospital liable for failure to request data from another hospital regarding its summary suspension of practitioner.
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Hongsathavij v Qeen of Angels
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Governing Body is ultimate authority - Board overturned hearing committee recommendation to reinstate call panel membership.
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Osooki v Fountain Valley
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Failure to disclose - Ophthalmologist did not disclose all prior hospital affiliations on application.
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Rao v Auburn
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Personality may be considered. Physician denied privileges after reports from other hospitas on termination/restriction of privileges. Personality may be considered.
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Harrell v Total Health Care
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The Managed Care Organization in this case was not held liable for negligent credentialing because State law granted immunity to non-profit health.
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McClellan v HMO Pennsylvania
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Ostensible Agency - MCO found liable for providers action due to negligent credentialing.
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Ostensible Agency
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Responsibility due to appearance of control
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Robinson v Magovern
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MD brough anti-trust suit against the hospital after his application was denied. Court found that hospitals may limit competition if they carefully follow objective criteria, bylaws and policies.
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Miller v. Eisenhower
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Denial of application due to physician's inability to work with others, no quality of care issues identified. Court held that disruptive behavior must be a real danger to qualtiy of medical care.
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Administrative Law
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Regulations enacted by state and federal agencies to implement statues and regulatory requirements.
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Common Law
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Judicial decisions that decide the outcome of litigation.
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1789
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U.S. Constitution went into effect.
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27
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The number of amendments in the Constitution
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15 days
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Adverse action reports must be sent to state llicensing boards within
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Statutory Law
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Legislation passed by Congress
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Main Motion
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This motion introduces items to membership for consideration and cannot be made when any other motion is on the floor.
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Subsidary Motion
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This motion changes or affects how a main motion is handled. Subsidary motion is voted on before a main motion.
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Call for Order of the Day
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A request to follow the agenda
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Privileged motion
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This motion brings up items that are urgent - unrelated to pending business. Take precedence over all other motions.
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A motion to divide the assemble
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A more exlicit type of vote (show of hands)
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Formal Grievance
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A written or verbal complaint that is made to the hopsital by a patient or the patient's representative
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7 days
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Hospitals are required to respond to patient grievances within
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ACGME
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Established in 1981, evaluates and accredits medical residency programs in the US
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CPCS
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Certified Provider Credentialing Specialist
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Deeming
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Authority granted to an accrediting organization by CMS - meets conditions of participation
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CPMSM
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Certified Professional Medical Services Management
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CPT
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System used to report medical procedures and services to health insurance programs. Developed by AMA
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RBRVS
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Resource based relative value scale - 1992. payment to physicians determined
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2004 - NPDB
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NPDB allowed practitioner to add statements to the report
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1999 - HIPDB
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HIPBD - Healthcare Integrity Protection Databank began accepting reports
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Hospitals
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The only organization required to query the NPDB
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60 days
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Practitioner may dispute NPDB report within
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2010 - NPDB
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Expanded reporting actions against all providers
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HCQIA peer review protection
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Applies to MDs, DOs and Dentists only
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1986
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HCQIA was passed into law
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1990 - NPDB
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NPDB opened and began collecting reports
