Our Quality Assurance Program

Harmony Healthcare Quality Assurance, Compliance & Education Program

Harmony Healthcare Quality Assurance, Compliance & Education Program

Harmony Healthcare has proven Compliance, Audit and Support strategies. These processes start with the very first conversation with our seasoned recruitment staff and are built to allow for:

  • Depth:  An intense understanding on the strengths and weaknesses of each consultant
  • Facts:  Having concrete evidence that supports this understanding
  • Reinforcement:  Continued development of all resources to maximize talent

We provide a 3 pronged approach to ensure each Harmony consultant is providing a value added service and one that meets both the client’s and our standards.

1. Initial Review

  • The most important phase of any coding assignment occurs in the first 8-10 days.
  • While achieving desired productivity can take time, Accuracy standards should be achieved from the 1st chart a Harmony consultant touches until the project ends.  In order to ensure results, our consultants are put on a minimum 50% review for the initial week of the assignment, and at least 25% on the second week.
  • During the second week we finalize statistics that describe accuracy rates for both reimbursement categories & an overall accuracy rate that takes into account all potential codes including:  secondary diagnosis, morbidity factors, POA, and Severity of Illness.

This chart describes how we examine and proceed.

Above   95% Total Accuracy    Between 87%-95% Accuracy 86%   and Below
Cleared   to continue Assignment Kept on Review Let go   from assignment
  • In the  over 100 reviews we’ve conducted nearly 1/3 of all consultants land in the 87-95%.  This is the critical point in an assignment where our compliance team is faced with identifying trends and education opportunities our coders need in order to meet 95%
  • The consultant is then put on 50% review for an additional week after we provide proper education.  At that point we expect the consultant to hit 95% or we end the engagement
  • What we have noticed is that the issues for many consultants typically occur from poor orientations, a lack of understanding of hospital Policies & Procedures, or not understanding a query process. The issue is very rarely ability
  • Our QA team is excellent not only with identifying the areas that need work, but in providing the right education to get the consultant to meet our standards
  • Our initial review is built to find the consultants that are not going to succeed and remove them before they have coded numerous charts

2. Continued Audits

  • After a consultant reaches 95% during our initial review they are free to proceed on the account.  That does not mean they are free from additional reviews
  • We audit 3% of the charts that Harmony consultants code after that initial review through the completion of the assignment.
  • The reviews are performed and calculated monthly
  • Harmony provides each client (or manager) with detailed breakdowns of the results
  • If we  find any areas of coding not meeting standards a thorough action plan is put in place
  • All action plans or education strategies are discussed and reviewed by our clients.  Typically at this time our clients make additional suggestions, or provide any information that may reinforce the plan

3. Continued Education

  • Our QA team is excellent not only with identifying the areas that need work, but in providing the right education to get the consultant to meet our standards
  • All action plans or education strategies are discussed and reviewed by our clients (monthly or quarterly).  Typically at this time our clients make additional suggestions, or provide any information that may reinforce the plan
  • The final piece of our on-going QA is the education we provide our consultants on a quarterly basis such as updated coding clinics
  • Monique Teague-Borden, CCS, CCS-P, CDIP is responsible for rolling out all of the updated coding clinics, and reviews all QA audits to identify potential education opportunities as a company
  • Monique has served as a compliance manager for large health systems, and her expertise combined with her strong desire to teach provides Harmony a unique asset to oversee both the Quality Assurance and educational processes
  • Starting in October 2013 Harmony’s continued education will also consist of on-line modules with ICD-10 education

Questions? Call Harmony Healthcare today!  813-369-5159