QAPI

Course overview

Accrediting agencies are looking at the Conditions of Participation (CoPs), however, the Centers for Medicare & Medicaid Services (CMS) uses the Medicare benefit policy manual which contains the conditions of payment; your agency needs to understand both. Backend Quality Assurance (QA) and Performance Improvement (PI) slows down both identification and resolution of issues and pushes the timeline for improvement in stars, Value-Based Purchasing (VBP) to a year or more. Agencies are often blind sided with Additional Documentation Reviews (ADR), Recovery Auditor Contractor (RAC), and Zone Program Integrtity Contractor (ZPIC) audits despite high marks on surveys because they are auditing from accrediting guidelines, not CMS triggers. CMS is using algorithms to look at every OASIS you submit. Top triggers are over utilization and indications that medical necessity and homebound status are questionable. New CoPs are only meeting the requirements accrediting agencies are already using.