This content was originally published on April 28, 2020
Regulation changes due to PDGM and updates to deal with COVID-19 are highlighting more than ever the importance of outsourcing QA audits. Quality Assurance (QA) audits add support to home health care agency teams and ensure clinical documentation improvement and compliance.
The transition from the old prospective payment system to PDGM was just one of the many regulatory changes agencies had to manage. All the while, agencies work to increase revenue and hold margins. And now, agencies must adjust to the new final rule on how to address, code, and bill for COVID cases.
New workflow processes, short-staffing issues, and in many cases, PPE shortages further compromise all these changes. Additionally, every agency is working to maintain and improve Star Ratings and Home Care Compare scores.
Agencies have all they can do to keep pace in an ever-changing regulatory environment. At the crux of it all, you must factor in the most important job of home health agencies: patient care.
The initiatives required to ensure viability in a PDGM model also are good business practices in any payment model. They are difficult, but not impossible to achieve. For virtually every agency it’s a matter of resource management, which means ensuring every staff member is working to his or her highest level of competency and, potentially, finding trusted partners that can provide operational solutions to your biggest challenges.
Why outsource quality assurance audits?
Expertise: CMS rules and guidelines governing the conditions of participation are complex. McBee only uses professionally licensed nurses and therapists to conduct all QA audits. Hiring procedures include careful auditor screening, regularly training to new rules and guidance, and routine monitoring to ensure continued accuracy.
No Bias: Expertly trained auditors have no bias when it comes to the audit tool or the employee being audited. Agency leaders can be assured no employees are unfairly targeted or unfairly given good/great results when they are not earned.
Efficiency: Expert auditors have the knowledge and skills to quickly review charts for compliance with conditions of participation, conditions of payment, and best practices. Because this is all they do, they do it more efficiently than a staffer who is also responsible for quality assurance, or intake, or scheduling.
Lower cost of doing business: Outsourcing QA can reduce the number of full-time positions or allow you to focus your staff on the most important work: patient care. Working with the right outsource partner also can help lower your annual training costs. Reporting on individual and agency-wide knowledge and skills gaps from your vendor helps you pinpoint precisely where to target necessary training.
Why highlight the importance of outsourcing QA reviews?
For your patients. Above all, remember why you are in this business: patient care. Keep the patient at the center of care: needs, goals, interventions, and outcomes.
McBee supports your team to enhance clinical documentation improvement and compliance.
If you find all of this overwhelming, McBee can help. We provide QA reviews. We also provide expert quality services for outsourcing coding, OASIS, billing, and more. Let our services relieve some of these burdens so you can focus on care provision.