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Demystifying QMR

Demystifying QMR. What to Expect When Your System is Selected. Notification Preparation The Review Preliminary Findings Final Report Follow Up. The QMR Process. Date of review List of children List of documents that must be available Information about family interviews Notice sent

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Demystifying QMR

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  1. Demystifying QMR What to Expect When Your System is Selected

  2. Notification • Preparation • The Review • Preliminary Findings • Final Report • Follow Up The QMR Process

  3. Date of review • List of children • List of documents that must be available • Information about family interviews • Notice sent • One week in advance for site visits • Two weeks in advance for desk audits Notification

  4. Local Site Visits • Desk Audits Local System Preparation

  5. Review Elements • Self-Assessment Tool • Communication with Local System Manager • Missing Information • Questions and Clarifications • Exit Interview The Review!

  6. Written Report • Within 30 days of review • Includes • Purpose of review • Overview of strengths, required TA, need for IP • List of retractions • Opportunity to provide additional documentation • Opportunity to make billing adjustments Preliminary Findings

  7. Sent via Certified Mail • 30 days after preliminary report, or • 30 days after receipt of additional information • Includes • Strengths, Required TA, Required IP • Family Interview Summary • Final Retraction List • Info that will be sent to DMAS Fiscal Unit • Appeal Process information (30 day timeline) Final Report

  8. DMAS • DMAS Fiscal Unit – Follow Up on Retractions • Local System • Communicate Findings to LLA staff and contracted providers • Develop/Implement Improvement Plan • ITCVA Monitoring and TA staff work with LSM • Required TA • Oversight of Improvement Plan QMR Follow Up

  9. For the Review itself • Site Visits • Desk Audits • For Positive Findings • Ongoing mechanisms for assuring qualified providers, adherence to requirements, quality services, effective processes, including documentation • Sample Tool • For Follow up Success Strategies

  10. Family satisfaction; perception that services have made a difference in child’s development • Requirements usually met • Some great examples of coaching, communication and collaboration, and documentation Trends - Strengths

  11. Documentation requirements • EI Processes and procedures • ASP, IFSPs, IFSP reviews • Determining outcomes/goals • Determining services – team process • Service delivery • Assuring qualified providers • Accurate billing Trends – TA/IP Needs

  12. Missing/late Physician Certification • Practitioner not qualified • Incorrect codes • Billing more time than documented and/or than specified by IFSP • Billing date doesn’t match date of service • No evidence that parent was present Trends - Retractions

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