CCMC Glossary of Terms Related to Accreditation
Accreditation: A standardized program for evaluating healthcare organizations to ensure a specified level of quality, as defined by a set of national industry standards. Organizations that meet accreditation standards receive an official authorization or approval of their services. Accreditation entails a voluntary survey process that assesses the extent of a healthcare organization’s compliance with the standards for the purpose of improving the systems and processes of care (performance) and, in so doing, improving patient outcomes.
Utilization Review Accreditation Commission (URAC): A not-for-profit organization that provides reviews and accreditation for utilization review services/programs provided by freestanding agencies. It is also known as the American Accreditation Health Care Commission.
CARF: Commission on Accreditation of Rehabilitation Facilities. A private, non-profit organization that establishes standards of quality for services to people with disabilities and offers voluntary accreditation for rehabilitation facilities based on a set of nationally recognized standards.
JCAHO: Joint Commission on Accreditation of Health Care Organizations.
Overview
The Utilization Review Accreditation Commission (URAC) is the credentialing body for case management. Their case management standards cover important areas such as scope of service, case management process, organizational ethics/confidentiality, complaints and staff. URAC standards require case managers to have annual professional educated in current case management principles and practices. The standards also require a description of: the types of clients served, the delivery model for case management services, and the qualifications of the case management staff.
Other standards include:
- guidelines for caseload
- A physician available for consultation
- criteria for identifying case management clients
- disclosure to clients the nature of the case management relationship
- documentation of consent
- policies to document patient assessments
- criteria for discharge
- policies and procedures for patients to file a complaint
