Quality Management
Purpose:
AllMed's Quality Management Program assists in developing and implementing the best possible system for the delivery of independent medical review determinations. This is an ongoing program that emphasizes professional conduct and demeanor, accessibility for all parties, and accurate efficiency. It provides for communication as an integral component, both within the company and between the company and its clients and referring entities. It provides for the identification and resolution of problems thereby promoting effective, timely, accurate, and standardized service to clients and referring entities.
Goals:
The goal of the Quality Management Program is consistency in company practice of external medical review through:
- Assuring compliance with regulatory and accrediting standards
- Organizing and evaluating the accuracy of data and the reports generated within the office
- Integrating activities between departments
- Initiating corrective action where problems are identified
- Identifying continuing education needs of staff
Quality Management Program Mechanisms:
AllMed uses a number of practices for monitoring and evaluating the quality of external/independent medical review including, but not limited to:
Monthly audits:
- Notice of Determination for Expedited Reviews
- Notice of Determination for Non-expedited Reviews
- Peer Review compliance with elements of review
- Concurrent audits of accuracy, privacy, security
- Analyses of credentials information and reports of determinations
- Customer satisfaction surveys, complaint resolution
