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ALL ABOUT URAC accreditation

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by

Charlene Jordan

on 7 October 2013

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Transcript of ALL ABOUT URAC accreditation

What is URAC?

Lash Group and URAC

The Pursuit of URAC

Lash Group is seeking URAC Health Call Center Accreditation
Accreditation will apply to Clinical Services in the Frisco, Rockville, and Monroeville sites

Accreditation is identified as a key strategic marketing objective for Clinical Services
Accreditation is highly recognized by the industry, existing clients, and potential clients
Accreditation has the potential to be a differentiator for Lash Group

Accreditation provides value to the organization by providing the opportunity to:
Assess our organization at all levels
Strengthen and improve our processes, maximize operating efficiencies, increase customer value and expand in marketplace


Accreditation Timeline

URAC Accreditation Scope

Standards
168 Standard Elements
37 Mandatory

Impacts all levels of the organization

Clinical Services
Expected to be well-defined and standardized
Program Specific
Reflects unique activities specific to each program
Inter-Departmental Coordination
Must show that all areas communicate and work together
Coordination with External Entities
Organization
Expected to have structures, processes and a quality based operation in place to support patient centric health call standards and best practices
Requires expertise and deliverables in many non-clinical functional areas of the organization



URAC Accreditation Scope: Impact

URAC Accreditation Scope: Impact

URAC Accreditation Scope: Impact

Organizational
Structure

Vendor Assessment




Organizational
Vendor Assessment Procedure (criteria, approval)
Company vendors
Service Agreements & SOWs
Requirements such as periodic review and reports from contractor
Clinical Services
RN services
Iron Mountain
Shred IT
Program
Accordant

Regulatory




Organizational
Training Program
Requirements
Qualifications
Learning Portal
Clinical Services
Staff qualifications
Clinical vs. non-clinical
Training requirements
Continuing education
Training materials
Program
Training records (license)
Clinical decision tools
Training to identify regulatory requirements

Training




Organizational
Governance Structure
Standard P&P process
Continuous Improvement
Clinical Services
QMS to address needs of customers, clients, patients
Standard Services
Quality Improvement Projects (2)
Safety Committee
Program
Document core business processes, adherence
Performance metrics
Telephone performance




Organizational
Organizational Chart
Reporting Structure
Description Key Stakeholders
Internal /External Reporting Requirements
Mission/Vision
Description of business functions
Clinical Services
Same as above
Description of Programs
Program
Same as above
Clinical and Non-Clinical

Quality Management







Organizational
Compliance Program
Internal Audit of Program
HIPAA
PHI
Clinical Services
Licensure (State)
Certifications
Sr. Clinical Staff requirements and responsibilities
Fraud, Waste, Abuse
Program
Trained on all regulations




Functional Area Deliverables




Organizational
Collects/obtains information on client satisfaction
Clinical Services
Client and patient surveys,
Addresses and analyzes patient / client complaints
Reviewed & Reported
Program
Customer Complaints
Escalation of Issues
Patient Rights
Patient Safety - response to threats (suicide, child abuse, recalls)






Organizational
BCP Plan
DR Plan
Resource Planning
Documented Testing
Back up and Restore
Clinical Services
Service specific
Facility specific
Program
Emergency procedures
Remote Workers







Client & Patient Satisfaction






Organizational
Physical and Logical Security - breaches
Data Integrity, storage, destruction for electronic and paper based
Periodic Access
Information Management P&Ps
Clinical Services
Periodic Access
Program
Remote Workers
Data entry accuracy, audit
IRMS, TheraCall



Information Management & Security





Organizational
General communication materials for clients (Web as well)
Ensure accuracy and reviewed ongoing basis
Requires written process
Clinical Services
General communication materials for patients
Ensure accuracy and review ongoing basis
Program
Same as above
DDC, Portals, brochures








Organizational
Contracts
Service Agreements
Must show how we measure and improve our services
Clinical Services
Review contract on site
Requirements (criteria for eligibility, description of potential health benefits of program)
Program
Describes procedures for opt-in, opt-out, how to dis-enroll from program



Marketing and Sales

Functional Area Deliverables
Written Business Agreements

Business Continuity & DR

Mandatory URAC Standard Elements

Mandatory URAC Standard Elements

Mandatory URAC Standard Elements

Marcia Mahler, Project Lead
Email: marcia.mahler@lashgroup.com
Telephone:

Kenny Johnson, Project Manager
Email: kenny.johnson@lashgroup.com
Telephone:

Email the URAC Team or contact the team members below:

Questions

Mandatory URAC Standard Elements

ALL ABOUT
URAC Accreditation

Full transcript