Quality checking dispute process for Medicare 111-23051519

Staff:

• can dispute Quality Control System (QCS) quality checking results on the:
• Medicare Quality Control System (QBBI)
• Quality and Support Tool (QST)
• Report Management and Distribution System (RMDS)
• can initiate a quality checking dispute if they receive incorrect feedback or an unwarranted error
• must refer to their Quality Check (QC) feedback email and speak to their Team Leader

Quality Checkers have the right of reply if the original decision and/or feedback provided is deemed incorrect. This includes where other errors or actions were not initially identified from the check.

This dispute process is based on the Quality Dispute Policy.

Staff:

• can dispute Quality On Line (QOL) and Quality Management Application (QMA) checking results
• may dispute a quality checking outcome if they think it is incorrect

Timeframes

Staff must lodge a dispute:

• within 30 days of the quality check being completed, or
• within 14 days of returning to work if they were on leave for the 30 days after the quality check. Their manager must confirm they were on leave

If staff lodge a dispute outside the required timeframe, it will be finalised without review.

Staff responsibility

Staff must:

• finalise all actions on the customer's record before lodging a dispute. They must:
• finalise all actions as a priority
• talk to their Team Leader if unsure of the correct action to take
• support their dispute with evidence. This is:
• the relevant Operational Blueprints (including Table and Step numbers and historical versions where they apply), and/or
• other nationally endorsed references current when the quality check was completed. For example, Network News Updates (NNU) or Roxy

Staff must not 'HOLD' or leave a 'NOT' or 'STA' activity on the customer's record, pending the outcome of a dispute.

Independent Reviewer requirements

• A Service Support Officer (SSO) in the Health Service Delivery team (HSDD Aged Care Customer) with the relevant technical expertise
• If the SSO network does not have the technical expertise in a particular area, they will consult with a technical specialist
• The SSO may need technical or policy advice to make their determination. For example, refer to Business Process or Level 2 Helpdesk
• The SSO must have access to the QMA Dashboard for SSOs. See the Resources page of Quality Management Application (QMA) in Process Direct for a link to the dashboard:
• Access to the QMA Dashboard is limited to 6 months
• SSOs should reapply for access before it expires (no expiry reminder is sent)

The independent reviewer will decide if the outcome of the dispute is:

• Upheld - the original quality check decision is correct
• Upheld for different reason - the original quality check decision is correct, but for a different reason. For example, other errors that were not identified in the initial check resulting in the same checking outcome
• Overturned - the original quality check decision is overturned

The independent reviewer will finalise and return the dispute to the staff member if:

• there is not enough evidence to support the dispute, or
• they cannot find the activity (incorrect Activity Management Record (AMR) or Work item ID)

The dispute can be reopened if the staff member provides the required information.

The independent reviewer will finalise the dispute without review if:

• the dispute is lodged outside the timeframe
• the error is not proficiency impacting
• there is an individual error within the quality check that, if overturned, will not impact the overall outcome of the quality check

Generally, when the QOL/QMA dispute decision is finalised, there are no further escalation steps available. However:

• Team Leaders may make a case demonstrating that the dispute outcome is potentially incorrect
• The Aged Care Customer team will investigate and determine the next steps
• Service Officers must not contact the Independent Reviewer or Quality Checker once a dispute has been lodged or determined