Quality Assurance & Integrity Database
Automated, rules-based, quality assurance application for healthcare providers.
The Quality Assurance and Integrity Database (Q-Aid) application is the flagship product of Rady Children’s Hospital—San Diego’s (RCHSD) Revenue Cycle Applications (RCA) group. With limited QA functionality in the enterprise-wide healthcare information system (HIS), Q-Aid was developed to address the complex and dynamic registration requirements. By capturing the 1,200+ business rules required to enter an accurate registration record in a rules-based system, Q-Aid is able to ensure that 100% of registrations are accurate. Rules regarding policy number formats, authorization requirements, appropriate mnemonic selection and other payer requirements are facility specific and can be rapidly created or modified to address facility, county or state-specific requirements. Registration data records are interfaced from the HIS to Q-Aid where they are validated for accuracy against the provider’s Q-Aid rule-set. Records that violate rules are flagged and can be corrected real-time before the error enters the revenue cycle and negatively affects reimbursement.
Improve Cash Flow
The upfront QA process that Q-Aid facilitates catches errors made at the time of registration. When a recurring error during the registration process is identified, a Q-Aid rule can be implemented immediately to communicate the error to the registrar and prevent a data entry error before it affects reimbursement. The ease of adding new and complex data validation rules to Q-Aid immediately prevents a negative impact on cash flow.
Reduce Unbilled Inventory
Identifying recurring causes for held or unbilled claims and implementing a preventative Q-Aid rule allows the provider to take rapid corrective action and directly have a positive impact on the revenue cycle. For example, rules regarding the specific policy number format (i.e. 3-alpha then 8-numeric characters) alert the registrar to correct the error and allows the bill to pass cleanly through the claim scrubbing application without increasing the unbilled inventory or requiring any manual intervention by the billing team.
Reduce Denials
In addition to facilitating upfront review in a patient access representative work queue, Q-Aid provides an interface for secondary review by leadership or dedicated QA staff in a separate work queue. This permits the scrubbing of registration records for non-patient access related issues. For example, queues-specific rules to address claim rejections received from the clearinghouse can be implemented and limited to the secondary review queue. By having queue-specific rules and record assignments, Q-Aid provides a centralized system for capturing all business rules that can negatively impact reimbursement.
Reporting
The reporting module of Q-Aid is extensive and includes accuracy results by patient access representative. The data is ideal for performance management and for aligning individual, team and facility goals and incentive programs.
Contact:
Rady Children’s Hospital San Diego
Revenue Cycle Applications Group
3020 Children’s Way, MC 5002
San Diego, CA 92123
Phone: 858-966-4962
Fax: 858-966-8686
E-mail: bduncan@rchsd.org