Attachment_J.2-C_TO_0001_Evaluation_and_Audit_Measures_Table_BFCC_NCORC_red-lined_6.29.18.docx
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- Solicitation number
- 75FCMC18R0034
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Attachment J.2-C TO 0001 Eval and Audit Measures Table BFCC NCORC red-lined
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| Attachment J.2-C | Evaluation and Audit Measures Table | |
| Annual and 54th Month Evaluation Criteria Measures |
Evaluation Measures (Subject to Modification by CMS)
Task Order: National Coordinating & Oversight Review Center (NCORC)
Aim: To provide the BFCC-QIOs the opportunity to evaluate satisfaction with their customer service experience with the BFCC-NCORC
Meas.
No.
| Measure Name |
| Desired |
Outcomes Required Service
| Performance Standard |
| Acceptable Quality Level (AQL) |
| Monitoring |
Method Incentives/Disincentives for Meeting or Not Meeting the Performance Standard
| 1 |
| BFCC-QIO Experience with BFCC-NCORC |
The BFCC-NCORC shall provide excellent customer service between CMS, BFCC-QIOs, and other stakeholders.
The BFCC-NCORC shall provide technical assistance and support to the BFCC-QIOs for all BFCC-related activities by serving as the liaison/communicator between CMS, QIOs, and other stakeholders. The BFCC-NCORC must be effective in the following customer service domains in its interactions with the BFCC-QIO:
· Communication
· Courtesy & Respect
· Accessibility & Responsiveness
85% Satisfaction Score on the BFCC-QIO Experience Survey of the BFCC-NCORC customer service
| 85% Satisfaction Score on the BFCC-QIO Experience Survey of the BFCC-NCORC customer service |
| Report to |
COR/SME
Numerator:
Total number of completed BFCC-QIO surveys for BFCC-NCORC customer service with a positive experience score
Denominator: Total number of completed BFCC-QIO surveys conducted for BFCC-NCORC customer service
Data Source: BFCC Survey Center (BFCC-SC)
· CPARS Performance Rating
· Public Awareness
· CMS Award
· CMS Quality Conference
Task Order: National Coordinating & Oversight Review Center (NCORC)
AIM: To ensure the standardization of all patient safety reviews and to efficiently pre-screen medical records that have a high likelihood of having an adverse event
Meas.
No.
| Measure Name |
| Desired Outcomes |
| Required |
Service Performance Standard
| Acceptable Quality Level (AQL) |
| Monitoring |
Method Incentives/Disincentives for Meeting or Not Meeting the Performance Standard
| 2 |
| Timeliness of Clinical Data Abstraction Center (CDAC) Independent Reviews |
| The BFCC NCORC shall complete independent case reviews within timeframes defined in the task order. |
| Independent case reviews completed within mandated timeframes. |
| 95% of CDAC independent case reviews by the NCORC will have the review completed within timeframes defined in the task order |
| 95% of CDAC independent case reviews by the NCORC will have the review completed within timeframes defined in the task order |
| Numerator: |
Total number of CDAC cases independently reviewed by the NCORC completed within timeframes defined in the task order
Denominator:
Total number of eligible CDAC cases independently reviewed by the NCORC during the reporting period
Inclusion: All cases initiated and completed during the reporting period
Exclusion: Cases initiated or concluded outside of the reporting period
Data Source: CMS Designated Case Review System - Quarterly Report
· CPARS Performance Rating
· CMS Award (Certificate/plaque)
Annual Performance Audit Measures Reviewed by NCORC (Subject to Modification by CMS)
BFCC Aim 2 Task Order: Beneficiary Protection- Case Review Services
Achieve 95% compliance with CMS requirements for Memorandums of Agreement and Physician Acknowledgement Statements over the contract period of performance.
Meas.
No.
Measure Name Desired Outcomes Required Service
| Performance Standard |
| Acceptable Quality Level (AQL) |
| Monitoring Method |
Incentives/Disincentives for Meeting or Not Meeting the Performance Standard
| 1 |
| Memorandum of Agreement (MOA) Regulatory Compliance |
Providers participating in the Medicare program, are required under federal law to have a Memorandum of Agreement (MOA) with a QIO. MOAs outline the QIO’s and provider’s responsibilities during the review process.
The BFCC-QIO must effectuate:
· Section 1866 (a)(1)(E) of the Social Security Act (The Act) requires providers of services to have an agreement with QIOs to release data related to patients when a QIO requests it.
· Section 1866 (a)(1)(F)(i) of the Act requires hospitals which provide inpatient hospital services paid under the Prospective Payment System (PPS) to maintain an agreement with QIOs to review the validity of diagnostic information provided by such hospitals, the completeness, adequacy and quality of care provided, the appropriateness of admissions and discharges, and the appropriateness of care provided for which additional payments are sought.
· Section 1866 (a)(1)(F)(ii) of the Act requires hospitals, critical access hospitals (CAHs), skilled nursing facilities (SNFs), hospices, LTACs, CORFs, and home health agencies (HHAs) to maintain an agreement with a QIO to perform certain functions.
| 95% compliance with execution of Memorandums of Agreement |
| 95% compliance with execution of Memorandums of Agreement |
| BFCC NCORC Performance Audit Criteria |
*Monitoring at month 12 and month 24
Numerator: Number of MOAs that meet regulatory requirements
Denominator:
A sample of 25 MOAs during the reporting period
Exclusion: Providers that refuse to execute MOA with BFCC-QIO and that refusal is documented and reported to the CMS Regional Office
· CPARS Performance Rating
| 2 |
| Physician Acknowledgement Statement Regulatory Compliance |
| Hospitals that are paid under the prospective payment system (PPS) have provided a signed acknowledgement from physicians who are being granted admitting privileges at the hospital. |
| The BFCC-QIO must monitor compliance with CMS regulation at 42 CFR 412.46 and ensure that each hospital has a physician acknowledgement statement on file for physicians billing for services provided in that hospital. |
| 95% compliance with execution of Physician Acknowledgement Statements |
| 95% compliance with execution of Physician Acknowledgement Statements |
| BFCC NCORC Performance Audit Criteria |
Numerator: Number of Physician Acknowledgement Statements that meet regulatory requirements
Denominator: A sample of 25 Physician Acknowledgement Statements during the reporting period
Inclusion: All Physician Acknowledgement Statements
Exclusion: none
· CPARS Performance Rating
· Visibility of Performance Audit Results
| 3 |
| Quality of Care (QoC) Letter Compliance |
| BFCC-QIO QoC complaint review letters to Beneficiaries must be written in plain language and address all written complaints. |
| The BFCC-QIO shall meet all contractual requirements including those outlined in the QIO Manuals with reference to QoC complaint reviews. |
| 90% of Beneficiary QoC complaint review letters will meet contractual and QIO Manual requirements |
| 90% of Beneficiary QoC complaint review letters will meet contractual and QIO Manual requirements |
| BFCC-NCORC Performance Audit Criteria |
Numerator: NCORC sample of 10 cases per service area per quarter
Denominator: All completed cases per service area per quarter
No Exclusions
Data Source: CMS Designated Case Review System
· CPARS Performance Rating
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