Eliminating The Mystery Behind Quality Control

Eliminating The Mystery Eliminating The Mystery Behind Quality ControlBehind Quality Control

October 2008 October 2008

MFWCAA MFWCAA ConferenceConference

Why Do We NeedWhy Do We Need Quality Control? Quality Control?

Payment accuracyPayment accuracy Timeliness Timeliness Negatives Negatives To ensure program access and To ensure program access and

integrityintegrity

Federal Fiscal Year (FFY)Federal Fiscal Year (FFY) The Federal Fiscal The Federal Fiscal

Year starts October Year starts October 11stst and runs through and runs through September 30September 30thth. .

Who is QC?Who is QC?

There are 9 QC reviewers.There are 9 QC reviewers. One person completes second party One person completes second party

reviews of all correct cases.reviews of all correct cases. One person completes second party One person completes second party

reviews of all error cases.reviews of all error cases. This person also handles all challenges, This person also handles all challenges,

differences, and case assignments.differences, and case assignments.

MN QC Review ProcessMN QC Review Process

Universe sample of all active MN Universe sample of all active MN cases with a food benefit – MFIP, cases with a food benefit – MFIP, FS, UH, and even GRHFS, UH, and even GRH

Random sample of casesRandom sample of cases 93 – 95 cases a month93 – 95 cases a month

Case AssignmentCase Assignment

QC receives the sample on the 1QC receives the sample on the 1stst working day or the 2working day or the 2ndnd of the of the month – whichever is later.month – whichever is later.

QC performs an independent QC performs an independent review of cases.review of cases.

Do they ever talk to each Do they ever talk to each other?other?

How Do I Find Out About How Do I Find Out About The Status of My Case?The Status of My Case?

Findings are compiled and Findings are compiled and issued via “snail” mail for issued via “snail” mail for most counties. most counties.

FindingsFindings What is the error?What is the error? Client or agency?Client or agency? How did QC discover the error?How did QC discover the error?

Challenge ProcessChallenge Process

Counties are allowed 10 days to Counties are allowed 10 days to challenge QC findings challenge QC findings

Federal ReportingFederal Reporting

QC has 4 months to QC has 4 months to complete a case. complete a case.

90% deadline90% deadline 100% deadline100% deadline

Is State QC The Final Is State QC The Final Authority?Authority?

Federal re-review of Federal re-review of completed casescompleted cases

Federal re-review of Federal re-review of incomplete casesincomplete cases

NegativesNegatives QC has two months QC has two months

to complete a review to complete a review of negative actions. of negative actions. Most reviews Most reviews

completed using completed using only MAXIS. only MAXIS.

Sample size is 70 – Sample size is 70 – 80 cases a month80 cases a month

TimelinessTimeliness Includes the review of application Includes the review of application

processing and expeditedprocessing and expedited

Tips from QCTips from QC

When in doubt, When in doubt, DOCUMENT, DOCUMENT, DOCUMENT, DOCUMENT, DOCUMENTDOCUMENT!!

Send in policy questions! Send in policy questions!

We Continue to NeedWe Continue to Need

YOU!!!!!!!!!YOU!!!!!!!!!

Questions?Questions?

Tracy K. O’Brien, PAC, PAIDTracy K. O’Brien, PAC, PAID [email protected]@state.mn.us 651/431-3993651/431-3993