NCQA Accreditation Pitfalls

By Andrew Seale posted 04-17-2012 08:31 AM

 After working in the compliance segment for a while I've decided to put together thoughts, ideas and musings on a bunch topics. I'd like to muse about NCQA Accreditation's, HEDIS and DM Performance Measurements.

Part 1 NCQA Accreditation Pitfalls- Time to complete and Look back periods:
 When many organizations decide to go for NCQA accreditation the first time a lot of bad assumption are made as it is assumed this can easily be done in a “few months”.  This usually happens when a senior leader in the organization makes the assumption that assigning someone to the task will just get it done (without reading the required documentation).  Usually this means some nurse or manager in the compliance/clinical regulatory area gets stuck with the task. Once they begin reading the requirements reality dawns on them that this is at least a 12 month long undertaking (minimum look back period).  Now the manager has to go across the organization and make sure that all the required documentation exists and it has been in place for at least 12 months (documented process, policies and procedures).  How many organizations in the Health Care field work well inter departmentally and have clears lines of responsibility which is documented and well maintained?  If you know of a few please let me know. So now the accreditation team (which is usually no more than a couple of people) begins the arduous process of going cross departmentally getting documentation from the various departments.  This can be monumental task in its own right. First you need to determine which departments should have the documentation you are looking for. Then you have to determine who you need to talk to in that department. Once that has been figured out then you need explain why and what you need for accreditation. This can be painful as everyone has their own assumptions on what is “needed”.  When in doubt always refer back to the requirements on what NCQA is asking for. Use the examples they provide as the baseline.
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