QAPI Program Utilization_Manual

Monthly Submission Statistics Report and Error Summary Report by HHA (for past three months) Date: OASIS Monthly Submission Statistics Report If yes to either probe, investigate: Is HHA submitting data less often than monthly? ............ Y † N † • Policies/procedures for receiving, tracking, data entering and transmitting OASIS data and correcting clinical records. Do we processes follow policies/ procedures? .... Y † N † Y † N † Does HHA have >20% rejected records? ................. Y † N † • If another organization (vendor, corporate office, etc.) submits data for the HHA: - Is there a written contract covering the arrangement? ................................................... - Does the other organization provide feedback reports to the HHA? ............................. Y † N † Y † N † • For 4-6 records selected for clinical record review, we kept printout of a final validation report showing that at least one assessment (e.g., SOC, F/U, Discharge) was received by the state. (Because we may not yet have submitted data for more recent assessments, it will be necessary to select patient assessments that were completed one to two months prior to the analyzes) - Can the we provide the requested final validation reports? ....................................... - Was at least one assessment per record (e.g., SOC, F/U, Discharge) received by the State? ............................................................................................................................. Y † N † Y † N † • If there is a high percentage of rejected records: - Is there a legitimate reason (e.g., a large batch of records was sent twice, and all records in the second batch were rejected)? .................................................................. - Can the HHA verify that its software conforms to CMS standards? ............................. Y † N † OASIS Error Summary Report by HHA Do the following errors appear on the report? Threshold met or exceeded? If yes, determine if the HHA's processes: Y † N † >20% Y † N † Ensure the 7-day lock requirement is met (Assessment forms are completed, reviewed, corrected as needed, and data entered and locked within a 7-day period). Y † N † >20% Y † N † Ensure that recertification assessments are completed between day 56 and day 60 of the certification period (HHA has system for notifying clinician that recertification is due and tracks incoming recertification assessments to ensure timely completion). Y † N † >10% Y † N † Track submission of complete patient episodes (SOC/ROC and corresponding Transfer or Discharge assessment for each patient). 102 (Inconsistent Lock date) (warning) 5460 (Inconsistent M0090 date; RFA 4 must be done on an every 60-day cycle) (warning) 1003 (Inconsistent effective date sequence) (warning) 909 (Inconsistent record sequence) (warning) Y † N † >10% Y † N † Track that assessments are submitted in the order they were conducted (e.g., SOC data are entered and submitted prior to recertification data). 67