QPI Healthcare Services is a unique and innovative data analytics company that offers compliance administration for payer performance requirements and quality metrics. Using our Lavear software solution, we decrease the administrative burden of providers’ by actively engaging Clinicians and Groups to expedite compliance with key performance indicators and regulatory requirements. This enables administrative staff to focus on operational priorities to close gaps in care and improve patient outcomes.
The requirements to obtain and retain payer relationships are not overlooked by our team. HARP Light Technology showcases all licensing and payer requirements, ensuring that risks are identified and mitigated, quickly and effectively. We follow the CMS Program Integrity Manual, Accreditation Standards, State Agency Standards, State Licensing Boards, State Departments of Health, and Commercial Insurance Carrier Program Integrity Manuals. Our team has a strong focus on Patient Outcomes, Quality Measures Data, eCQM’s, UDS, and more!
QPI decreases the healthcare providers organizational workload by assuming a large percentage of responsibilities that include human resources, administration, risk management and patient outcomes. Thus, we reduce the workload for key personnel while increasing the organizations revenue. Our series of checks and balances ensures that the organization runs smoothly and efficiently
Human Resources
Employee Files
- Employee List Including: Departments, Job Title, Timesheet, Holidays and PTO
- Employee Applications
- Orientation Checklist
- Job Descriptions
- 90 Day &Annual evaluations / Assessments
- Federal Verifications & Backgrounds Screenings Including Pacer, OIG, SAM, NSOS
- IRS Documentations Including: I9, W4, W9, 1099, and Contracted Agreements with BAA
Mandatory Education(LIP's & Non-LIP)
- Bloodborne Pathogens
- Conflict of Interest
- Cultural Diversity
- Emergency Management & Natural Disaster
- Fire Safety
- Fraud Waste and Abuse
- HIPAA Training
- Incident Reporting
- Infection Control
- OIG Compliance Manual
- Patients with Communication/Language Barriers
- Patient Bill of Rights and Responsibilities
- Patient Abuse
- Patient Concerns and Grievances
- Patient Referral Process
- Safety and Security
Credentialing for Individuals – See Risk Management & Credentialing below.
Administration
Corporate Structure Management
- Articles of Incorporation
- Employer Identification Number from the IRS
- Business Tax Permit(s)
- Lease Agreement
- State Licenses
- Insurances
- Federal Regulatory Agency Certificates
- Surety Bonds - Medicare, Medicaid, NPI, NPPES
Accreditation Organization Management (if applicable)
- Accreditation Preparation
- Survey Support
- Corrective Action Plans
- Change of Information
- Super User Web Portal Access - TJC
Credentialing for Individuals – See Risk Management & Credentialing below.
Risk Management & Credentialing
Licensing, Privileging, Enrollment, and Credentialing (LPEC) Strategy
- Implement, Monitor, and Maintain LPEC Strategy – Full data analysis of the organization.
- Completion of credentialing & re-credentialing applications and database attestations –payer and state-mandated applications.
- Preparation for primary source and reference verifications – this allows the health plans and facilities to efficiently process verifications by having the right contact information the first time.
- Confidential electronic storage of required credentialing documents (state license, DEA, CE/CME’s curriculum vitae, malpractice, certifications, etc.)
- Progress Tracking & Credentialing Updates
Licensing
- Taxonomies
- Specialties
- State License(s)
- Board Certifications
- DEA
- FDA
- Federal Verifications & Backgrounds Screenings Including Pacer, OIG, SAM, NSOS
- ECFMG
- Identify Verification
- Internship
- Residency
- Fellowship
- National Physician Database
- Insurances: Professional Liability & Malpractice
Enrollment
- Payor Enrollment
- Medicare - PECOS I&A
- Medicare Advantage Plans
- Medicaid Provider Numbers
- Medicaid Managed Accounts
- Provider Network Applications
- Appeals
- CAQH -Update Profiles & Quarterly Attestations
- NPI Application(s) and /or update NPI profile(s)
- Re-credentialing providers & managing re-credentialing dates
- Adding new service location(s)
- Revalidating Medicare and Medicaid
- Obtaining copies of Contracts & Fee Schedules
- Updating Network Directories
- Removing Reassignments
- Licensing (new/renewal)
- DEA/CPS - Controlled Substance Practitioner Registration (new/renewal)
- Managing and reporting expirables, including re-credentialing dates, hospital privileges, licenses & DEA
Privileging
- Hospital, Skilled Nursing Facility, Ambulatory Surgical Center, etc.
- Privileging package creation, audit, and verifications
- Completed Delineation of Privileges Form
- Completed Locum Tenens Practice Experience Form (if applicable)
- Work history including all practice locations and employment affiliations
- Current Curriculum Vitae with complete professional history in chronological order and no gaps (month and year must be included)
- Case log from the last 24 months (If applicable)
- Copy of college/university diploma and training certificate(s)
- Current CME (CME activity for the past three years)
Risk Management
Risk Manager Responsibilities-at-a-Glance
Payer Requests
- Appeals & Denials
- Palmetto GBA - SACU Audits
- Development Requests
- Corrective Action Plans
- Commercial Payer Audits
- Site Visit Report Response
- TPE’s - Targeted Probe Education & Review Audits
- SACU - Supplier Audit and Compliance Unit
- RAC - Recovery Audit Contractor Audits
- CERT - Comprehensive Error Rate Testing Audits
- UPIC - Unified Program Integrity Contractor Audits
Regulatory Training
Access to QPI's Legal Counsel
- Fraud Waste and Abuse Certification
- Anti-Kickback
- STARK
- Communication Hotlines
- Compliance Reviews and Assessments
- Internal Compliance Audits
- Cybersecurity
- Monitor State / Federal Regulations
Reporting Tools
- Sentinel Events Assessment
- Fire Drill
- Safety Assessment
- OSHA Assessment
- HIPAA Assessment
- Hazzard Assessment
- Incident Reporting
- Annual Evaluation and Review to Board of Directors
Patient Outcomes & Quality Measures
Quality Outcome Measures
- CMS, eCQM's Data
- Patient Stratification for Scheduling
- Identified Care Gaps
- CPT, ICD10, & CPT Category II Codes
- HCC (RAF Scores)
- Patient Experience Surveys
- Clinical Outcomes Monitoring
- Patient Concerns & Complaints
- Complaint Resolution Reporting
- Medical Billing & Coding Audits
- Revenue Monitoring through billing audits
Reputation Management Tracking
- Google Reviews
- HealthGrades.com
- Local.yahoo.com
- NursesRecommendDoctors.com
- RateMDs.com
- Revolutionhealth.com
- Vitals.com
