QAPI Program Utilization_Manual

staff profiles for consideration at the time of evaluation. QAPI Annual Evaluation, Report The Quality Assurance Plan are reviewed and approved annually by the Agency Board of Directors, QAPI, and other appropriate Agency staff. STAFF FUNCTIONS Agency staff functions include the following: · Participation on Performance Improvement project teams either by selection or based on voluntary assignment according to interests, expertise, or knowledge · Participation as project team facilitators to help coordinate Performance Improvement team functions, prioritize activities, and report on status of Performance Improvement activities. · Attendance at educational offerings, as appropriate · Offering input, suggestions, or recommendations to project teams · Assisting in collection, management, and analysis of data. QUALITY ASSURANCE, PERFORMANCE IMPROVEMENT COMMITTEE (QAPI) The QAPI Committee is composed of health care professionals representative of services provided by the agency, it is approved by the Governing Body. It meets to review policies and procedures, provide consultation to staff, and make recommendations for improved patient care. A subcommittee of the QAPI Committee and staff meets quarterly to review the overall functioning of the agency. This includes review of clinical policies, position descriptions, and current accreditation reports. The review/recommendations are summarized on an annual review worksheet and submitted to the President of the Board of Directors. The President incorporates this review into the end-of-fiscal-year reports to the Board of Directors. UTILIZATION REVIEW COMMITTEE The Utilization Review Committee is a subcommittee of the QAPI Committee and is chaired by the Manager of Quality Improvement. Membership includes both agency staff and may be incorporated health care professionals external to the agency. The committee meets to review a random sample of current and discharged clinical records. Summary evaluations and subcommittee recommendations are reported to the Board of Directors. OTHER RESPONSIBLE STAFF Pre-billing review is the responsibility of supervisory or designated staff who review patient records to ensure that visits billed meet coverage criteria Risk management is accomplished by a review and analysis of patient complaints and incidents and is conducted on an ongoing basis by QAPI staff. Quarterly summary reports are prepared by QAPI staff and presented to the clinical staff/management. EXTERNAL MECHANISMS External Mechanisms for Performance Improvement include the following surveys, monitoring, and audits: · Medicare and Medicaid provider certification survey · Ongoing monitoring and annual financial audit by Medicare fiscal intermediary · Annual audits if needed by an independent CPA firm CONFIDENTIALITY The activities, minutes, reports, and correspondence related to QAPI activities are confidential and privileged. All requests for access to the QAPI reports must be submitted in writing and will be reviewed by the legal department for the agency. Access to such reports requires the approval of the President of the corporation. Quality Improvement records are maintained as confidential files. 61