services are impacted by not receiving the services that have been medically authorized. Local network providers are impacted by being unable to provide services that have been authorized as medically necessary. Selection Process [Core 19(b), Core 20(g), Core 21 (a)(b)(i),(ii),(iii)(c)(d)(e)(f) and Core 23(a)] The Health Utilization Management/Utilization Review unit observed a trend of unused outpatient units. A report was developed to show the number of units authorized and the percentage of those units used by the provider for a specific service. The report highlighted a low usage rate for the service of Individual Psychotherapy (90837) and Group Therapy (90853). The utilization of service codes 90837 and 90853 will be closely monitored for increases in use as the providers received technical assistance. The reports will allow a measurement over time to gauge increased utilization of the service codes identified. Relation to Modules under Review [Core 21 (a)(b)(i),(ii),(iii), Core 24(a)(b)] This quality improvement project fits with the Health Utilization Management module, Version 7.0. This project is designed to measure the increased utilization of service codes 90837 and 90853. Date approved by the Quality Management Committee Date of meeting minutes reflecting approval by Quality [Core 20(g)] Management Committee [Core 20(d)] April 22, 2014 April 22, 2014 Time Frames [Core 23(c)] March 2014 Formulated Quality Improvement Project to address low utilization rate of services. – March 2014 Developed a report to analyze trends in service code utilization. – March 2014 Collected baseline data from 2nd quarter FY 2013-2014. – Ongoing monitoring of service utilization and technical assistance to providers. – July 2014 Updated QIP and data based on transition to Alpha MCS – July 2014 (and forward) monitoring of service utilization and technical assistance to providers. – Focus of Project [Core 24(a)(b)] Name of Senior Clinical Staff Person Involved [Core 24 (b)] Dr. Anthony Carraway, Clinical Will targeted training and support tools assist community providers – Sandhills Center Medical Director
services are impacted by not receiving the services that have been medically authorized. Local network providers are impacted by being unable to provide services that have been authorized as medically necessary. Selection Process [Core 19(b), Core 20(g), Core 21 (a)(b)(i),(ii),(iii)(c)(d)(e)(f) and Core 23(a)] The Health Utilization Management/Utilization Review unit observed a trend of unused outpatient units. A report was developed to show the number of units authorized and the percentage of those units used by the provider for a specific service. The report highlighted a low usage rate for the service of Individual Psychotherapy (90837) and Group Therapy (90853). The utilization of service codes 90837 and 90853 will be closely monitored for increases in use as the providers received technical assistance. The reports will allow a measurement over time to gauge increased utilization of the service codes identified. Relation to Modules under Review [Core 21 (a)(b)(i),(ii),(iii), Core 24(a)(b)] This quality improvement project fits with the Health Utilization Management module, Version 7.0. This project is designed to measure the increased utilization of service codes 90837 and 90853. Date approved by the Quality Management Committee [Core 20(g)] Date of meeting minutes reflecting approval by Quality Management Committee [Core 20(d)] April 22, 2014 April 22, 2014 Time Frames [Core 23(c)] March 2014 – Formulated Quality Improvement Project to address low utilization rate of services. March 2014 – Developed a report to analyze trends in service code utilization. March 2014 – Collected baseline data from 2nd quarter FY 2013-2014. Ongoing – monitoring of service utilization and technical assistance to providers. July 2014 – Updated QIP and data based on transition to Alpha MCS July 2014 (and forward) – monitoring of service utilization and technical assistance to providers. Focus of Project [Core 24(a)(b)] Name of Senior Clinical Staff Person Involved [Core 24 (b)] Clinical – Will targeted training and support tools assist community providers Dr. Anthony Carraway, Sandhills Center Medical Director
QMC-Exec-Summary-Jan-March20151.docx