Our mission is to manage the programming and services standards of the agency and to monitor the results of our efforts in implementing these standards, while also being the primary liaisons with government regulatory agencies. This monitoring occurs in several ways:
Program Success Reviews
The foundation of our internal Quality Assurance effort involves the implementation of our Program Success Review protocol, which looks at all of the essential elements of each of our programs/service areas; from person-centered services to the physical environment. Reports are generated and distributed, plans of correction are solicited and approved if needed and those plans are monitored through their completion.
The Incident Review and Management Process
All agency consumer incidents are filed, investigated and managed by Quality Assurance staff, interacting with agency program staff, the OPWDD Incident Management Unit, the New York State Justice Center, local authorities and the agency’s Incident Review Committee. The agency Incident Review Committee membership includes front-line agency staff, a family member, members of the Board of Directors and a consumer representative.
Medicaid Billing Reviews
100% of agency-generated Medicaid billing requests are reviewed by Quality Assurance staff, after two preliminary reviews by program staff and prior to those requests being submitted to our finance department for final billing. Quality Assurance staff then perform random sample retrospective billing reviews to ensure that a percentage of those previously approved bills can be justified.
Quality Assurance is also responsible for the implementation of Medisked Connect, our primary electronic medical records platform, within our program areas. In coordination with our Information Technology and Finance departments, billing review protocol implementation is monitored and results are issued to all relevant parties.
Quality Assurance also provides: