• Quality Improvement, Quality Management, and Quality Assurance
• Patient Safety
• Clinical Resource Management
• Case Management
• Transitions of Care
• Accreditation Organizations
• Regulatory Environment
• Credentialing and Privileging
• Insurance and Managed Care
• Workers' Compensation Education
• Legal & Ethical Issues in Risk Management
• The Physician Advisor in HCQM

• Discuss the use of peer review in assuring quality of care in a variety of settings
• Discuss the evolution of the definition of error in medicine
• Explain various ways utilization is managed and costs are controlled
• Review legal and quality considerations specific to case management practice
• Identify essentials of safe and effective transitions of care
• Discuss the differences between accreditation, certification, and regulatory agencies
• Discuss critical regulatory issues (Stark law, Anti-kickback statute, etc.)
• Specify how credentials and privileges are granted, maintained, and removed
• Discuss publicly funded health programs such as Medicare, Medicaid, Tricare, and Indian Health Service
• Determine oversight in Workers’ Compensation and related programs
• Discuss the importance of the HIPAA Privacy Rule
• Recognize the importance of informed consent
• Describe the roles and areas of potential influence for the experienced physician advisor
• Explain the basic types of medical necessity reviews
• Describe how the definition of observation services differs from inpatient status

ACCREDITATION & CREDIT
In support of improving patient care, the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

This activity was planned by and for the healthcare team, and learners will receive 26 Interprofessional Continuing Education (IPCE) credit for learning and change.

Physicians
ABQAURP designates this enduring material for a maximum of 26 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurses
This activity is designated for 26 nursing contact hours.

Physician Associates
ABQAURP has been authorized by the American Academy of Physician Associates (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 26 AAPA Category 1 CME credits. Approval is valid until March 16, 2029. PAs should only claim credit commensurate with the extent of their participation.

Family Physicians
The AAFP has reviewed HCQM: A Review of the Core Body of Knowledge and deemed it acceptable for up to 26.00 Enduring Materials, Self-Study AAFP Prescribed credit(s). Term of Approval is from 03/17/2026 to 03/16/2027. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Osteopathic Physicians
This program is approved for Category 2 credit by the American Osteopathic Association.

This course is intended for Physicians, Nurses, and Other Health Care Professionals with appropriate CME / CE credit offered for each profession.

All participants must achieve a final assessment score of at least seventy percent (70%) for recertification and continuing education credits.

This activity is valid from March 17, 2026 - March 16, 2029.
Previously valid May 9, 2023 - April 30, 2026 and reviewed March 16, 2026.

Copyright © by the American Board of Quality Assurance and Utilization Review Physicians, Inc. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, including but not limited to the process of scanning and digitization, or stored in a database or retrieval system without the prior written permission of the publisher.

• Contact:
  Contact Education