The Assurance of Quality Assurance

by  Shannon O. DeConda, CPC CPC-I CEMC CEMA CPMA CRTT
Feb 5th, 2016 - Reviewed/Updated Aug 16th

Does your organization have a Quality Assurance (QA) plan in place? Does it contain policies for escalations or what to do when certain issues arise? Even organizations with the most experienced of auditors on staff can find extreme value in creating - and following - an effective quality assurance plan.

Many of us who view our job duties as a task-list or to-do's that need to be done tend to complete a project and quickly move to the next while enjoying the task of checking that item as 'done'. While every organization needs these 'work horses' to power through the job at hand, they also need the 'attention to details' teammate who looks up from their work and says, "hey, has that been QA'd?". No matter how good we may be at our jobs, human error occurs. This is why a QA program is beneficial. An effective QA program brings consistency in audit findings and interpretations for your staff.

When creating a QA program for your audits or when evaluating a firm to complete the task, there are several points to consider:

• Staff QA Requirements: It is important to consider who is being evaluated through the QA process. All auditors, regardless of experience or number of records audited, should be evaluated through a QA process. Auditing the auditor ensures ongoing education is fundamental and allows for continued identification of gray areas that may need internal policies to more accurately define a consistent interpretation.

• Volume QA Requirements: Setting a QA plan and escalation policy is imperative. Documentation Guidelines are 20 years old and are not clearly defined. Therefore, new staff to an audit team should have a higher QA requirement to ensure they are extrapolating the documentation accurately according to your auditing policies and procedures. This includes individuals with 10+ years of experience, but who may be new to the organization.

• QA Auditor: An organization should consider their preferences in who should perform the QA review. A good quality control process would be to outsource the QA review to a third party audit firm. This would allow an auditing process of your auditors with no additions to the current workload. Just be sure to vet their QA process! If choosing to internalize the process, an organization should consider the benefits of having one auditor as the "QA Director" versus having all of the auditing team auditing each other. Oftentimes, identifying someone on the team who has great attention to detail in the process may eliminate a "to-do" process from the QA program and protect the integrity of the process.

• Finding and Escalation Policies: The findings of the QA review should become part of an auditor’s employment record validating their strengths and the expertise of their auditing skills, or unfortunately noting deficiencies that must be addressed. There should be a clearly defined plan regarding acceptable precision ratings and the organization should have outlined acceptable QA parameters for their auditing team. This would be defined through an Escalation Policy of what happens when QA findings fall outside of the acceptable parameters. QA is not meant to be a process that threatens an auditors job, but if we hold physicians to precision error ratings, then why not the auditors who are scoring them, too?

This is not an all-encompassing guide to an auditing QA program, but merely an overview of some of the pressing concerns. As a client in pursuit of an auditing firm, you should expect a professional third party organization to have a healthy QA program and be able to provide details to validate the expertise of the auditing staff. As an organization, consistency and accuracy should be a foremost concern in order to substantiate the quality of the services provided.