Importance of Outsourcing QA Audits

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 is just one of the many regulatory changes agencies must 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 Health Compare scores.

Agencies have all they can do to keep pace in an ever-changing regulator 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?

Pros

Expertise: CMS rules and guidelines governing the conditions of participation are complex. QIRT 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.

Cons

Loss of control: The number one reason cited for choosing not to outsource operations and administrative tasks is the fear of losing control – control over workflow processes, control over quality, control over staffing. While that concern is understandable, you have more control over vendor output than you do over staff output. Outsource vendors are only as good as the last audit they did for a client. Handle repeated failure to meet expectations easily by ending the contract. There are all sorts of HR issues to navigate when terminating recalcitrant staff.

HIPPA protections: Many agency decision-makers worry that protected patient health information will be compromised. That’s a legitimate concern. It’s important when exploring outsourcing options that you know what protective measures a prospective vendor has in place. You must also ask how often those measures are reviewed and upgraded.

Cost: Always the CFO’s first question: what’s outsourcing going to cost? When looked at as a line item on your P&L, outsourcing can appear to be expensive. However, you should consider the cost savings of fewer employees, salary and benefits, or the value of having those same staff members perform work appropriate to their skill and education.

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.

QIRT’s Quality Assurance auditors support your team and ensure clinical documentation improvement and compliance.

If you find all of this overwhelming, QIRT 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. Find out more today at QIRT.com or email ContactUs@QIRT.com.

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