What is accreditation?
“Accreditation is a process of review that health care organizations participate in to demonstrate the ability to meet predetermined criteria and standards of accreditation established by a professional accrediting agency”.
Accreditation represents agencies as credible and reputable organizations dedicated to ongoing and continuous compliance with the highest standard of quality.
How to Improve Quality & Performance Documentation?
When it comes to DME accreditation, surveyors receive multiple inquiries on an ongoing basis regarding how to monitor quality continuously and improve the performance of their organization.
One of the first questions we suggest you to ask yourself is how you select the areas you would like to improve.
We find that most responses center on the Medicare Quality Standards and their guidelines. Often we find that companies look further and deeper into their organization to determine “why” that specific area, concept or process is important to their company and “what” they are expecting to achieve by managing and collecting data on those areas determined to need improvement. This is the “why” behind the “what.”
The concept of monitoring quality continuously is to locate, identify and correct any company weaknesses you expect to improve. You can better evaluate the importance of each area if you take the five areas Medicare requires you to review and break them down into smaller bites:
1. Beneficiary satisfaction with and complaints about products and services.
Complaint forms/logs seem to be the choice when recording information for this requirement. When documenting information, especially for a Medicare beneficiary, there are certain items (e.g., Medicare HIC number, written notification to the Medicare beneficiary of the results of its investigation and response within 14 days).
Record all information such as: the date and time of the complaint, name/address/contact information of complaint, detailed description of the complaint,and the resolution to the complaint. By documenting this information, there may be indications of deficiencies within your organization’s structure. By reviewing these quarterly, you have a better opportunity of correcting issues before your competition corrects them for you.
2. Timeliness of response to beneficiary questions, problems and concerns
Many organizations categorize this area as ‘incident reports.’ It is important to remember that these are your customers and they have choices as to where they receive their equipment and supplies. Addressing issues and concerns timely can create goodwill and hopefully satisfy your customers and to log the information you receive including the date and who contacted you, the reason for the concern, your follow-up actions, dates and resolution for that concern.
3. Frequency of billing and coding errors (e.g., number of Medicare claims denied, errors the supplier finds in its own records after it has been notified of a claims denial).
This review is based on billing, coding and other financial areas. Many organizations evaluate their billing process, how their billing errors can be better managed and which staff needs to receive additional training due to errors found within their scope of billing and collecting, what percentage of collections are received and what can be done to improve these results.
4. Adverse events to beneficiaries due to inadequate services or malfunctioning equipment and/or items
This may be identified through follow-up with the prescribing physician, other healthcare team members, or the beneficiary and/or caregivers. Most companies never experience an adverse event. Your policy and procedures should define what you deem an adverse event.
Example : “An adverse event is when a patient is hospitalized or passes away due to or caused by the organization’s equipment or service to the patient.”
There are definite time frames for researching and reporting an adverse event. You need to have a process regarding the time frames and who is contacted. There may be a variety of persons contacted, such as the manufacturer, your insurance agency, your attorney, etc.
Maintain a complete record of all pertinent information, time frames and what information was reported to whom; keeping in mind any adverse event must be reported to your accrediting body.
5. Impact of the supplier’s business practices on the adequacy of beneficiary access to equipment, items, services and information.
There are a wide variety of indicators within this area. Some monitor “after-hour” calls to ensure the patient’s concerns are satisfactorily provided in a timely manner. Other organizations may monitor a business activity such as hours of operation. They may question their own hours to ensure they are meeting the goal of the organization.
Within this review, you may choose to adjust the Service Tech/Delivery Personnel’s work hours. This may help you reduce the overtime dollars spent on late set-ups. Again, remember to record your results. When an indicator becomes a non-issue, select another business activity to monitor.
It is also be noted in the CMS Quality Standards that, the supplier can seek input from employees, customers and referral sources when assessing the quality of its operations and services.
Summarize and document your results and your findings on a quarterly basis. Define your intentions on improving the results of your quality program. Annually, at a minimum, bring your results to the organization’s leadership for further review and definition of how to proceed. Use this structured format to help your organization move forward. This program only benefits you when you use it.