Clinical Consulting Services – Utilization Review/QA
Our Utilization Review/Quality Assurance (UR/QA) department is directed by a Registered Nurse with over 22 years nursing experience and over 10 years of Utilization Review/Quality Assurance experience in the physician office. Our UR/QA department maintains a proven track record of maximizing payer incentives with a vast knowledge in all insurance quality programs, proper reporting of core measures, as well as proficient performance for federal programs including MIPS and ACO’s.
We can provide our clients with chart reviews relating to proper documentation of E&M visits, Annual Wellness Visits, Transition of Care Visits and correct quality codes regarding all preventive screenings and chronic care management required in patient care encounters. Education of current standards for documentation in the patient record can also be provided for both staff and physicians when applicable.
Our UR/QA department can also work with your office staff on standards of care, clinical office flow, clinical documentation and communication, as well as competency of clinical skills. We also strive to assist you in improving clinical inefficiencies for the benefit of your patients’ safety, health and well-being. We have a variety of approaches that will enhance the current workflow to increase staff productivity, prepare for the patient visit, and ensure that staff are maintaining communication efficiently and effectively with the patients and provider regarding tests, referrals, and authorizations.
- Establishing a culture of quality in your office. We can assist you in identifying policies and procedures in your office that will enhance and promote quality efforts as well as ensuring that your staff is operating as a team dedicated to improving the care of your patients and promoting proactive activities with every patient encounter.
- Prioritize opportunities for improvement. We can assist you in examining your patient population and determine what quality measures are being focused on within your encounters for the most common conditions in your practice.
- Understanding measures. We can provide education on measures developed from HEDIS and ensure you and your staff become better acquainted on how and when to use them.
- Goals. We can help you identify and set measurable goals and monitor those goals for quality within your practice.
- Commitment to ongoing quality evaluation. Quality improvement is a never-ending process. We will help you monitor your quality improvement processes and ensure communication by offering transparency to you and your staff when communicating results, addressing actions that need to be taken to improve, and revising workflow to gain the desired results.