Medicare Public quality checking in Quality and Support Tool (QST) 111-22042744

The Medicare Public quality checking process aligns Services Australia's Enterprise Quality Framework and the 7 quality principles.

See Resources for a link to the Enterprise Quality Framework.

The quality checking process:

• helps Team Leaders and Quality Checkers to identify process improvements
• makes sure that there is consistency in quality checking

Managers/Team Leaders are responsible for making sure:

• Quality checkers complete the process for quality checker accreditation
• Quality checkers hold appropriate skill tags in the Quality and Support Tool by sending an email to Quality Operations & Technical Support
• Timely error feedback is discussed with Service Officer as part of the coaching conversation to support any learning and development opportunities
• Analysis of errors. That is, if errors occurred because of factors such as limited training, understanding the business rules, environmental or system based issues
• Positive quality checking outcomes are acknowledged with Service Officer
• Analysis of data to identify learning needs or process improvement opportunities

Quality Checkers are responsible for:

• Carrying out quality checks as specified in the sampling plan
• Understanding and maintaining technical knowledge, procedures and policies
• Maintaining a correctness standard for personal accuracy
• Identifying root cause analysis and identifying systemic issues
• Reporting and escalating trends or concerns to their Team Leader
• Providing constructive and non-judgemental feedback including appropriate reference materials such as Operational Blueprint
• Explaining the impact of errors and action to be taken to correct the error (if applicable) when providing feedback

Quality checkers must not check their own work. If their work is selected, it must be given to another staff member who has been trained to conduct quality checks.

The Quality Team is responsible for:

• Providing administrative support for quality checking in the Quality and Support Tool (QST)
• Providing relevant reports as needed
• Arranging QST training for quality checkers
• Supporting the business with flexible and fit for purpose quality approaches

To attain accreditation, Quality Checkers must:

• have knowledge of relevant policies and procedures
• maintain a high correctness standard in the program they are checking
• have an understanding of the quality checking procedure
• meet accreditation standards annually

The Resources page has a link to the Medicare Public Accreditation process.

Quality checking accreditation must be renewed annually.

See Quality checker accreditation for Health Service Delivery Division for more details.

Pre-checks apply:

• to new starters
• when new processes are introduced

New starters have 100% of their work reviewed and corrected until deemed proficient. Any errors made in pre-check must be recorded as errors.

Targeted checks apply to:

• all Medicare Public work types in QST
• the following scenarios:
• in response to business triggers or when there is a consistent/long-term quality issue identified
• to Aim for Accuracy process (Check the Checker) which is completed every 12 months. This is to confirm the accuracy of quality checking results. The process involves rechecking a representative sample of previously checked work to determine if quality checking procedures have been followed correctly

To arrange a targeted check(s), Team Leaders send an email to Quality Operations & Technical Support with the staff member's details, the reason and the length of time needed for the targeted check.

Pre-checks proficiency requirements for new starters will be advised in the scope of training details.

Medicare Public Targeted checks only capture teams within Health Service Delivery.

The sample size is between 1-4% of the total volume processed and it is randomly selected for quality checking.

Timeframes

Quality checks are:

• undertaken daily on a random sample of work
• completed within 1-2 business days to make sure timely feedback

All quality checks for the month must be actioned within 3 calendar days of the following month. After this time, remaining work is abandoned.

Resources

Quality checkers must have access to the following to undertake quality checks:

• Program specific processing systems
• Processing and National Demand allocation (PaNDA)
• Quality and Support Tool
• Skill tags added on the Quality and Support Tool

For the purpose of quality checking, an error is information processed/keyed into the system, which does not match the documents submitted or the supporting documents uploaded to the systems.

Critical and non-critical errors

Error codes are categorised as critical and non-critical.

An error is defined as critical when there is a potential risk to:

• a customer's:
• privacy
• eligibility
• payments
• application assessment being finalised
• record
• the agency's reputation

An error is defined as non-critical when it does not meet the above criteria. Generally, this relates to administrative errors.

Only critical errors are used to calculate the health status of the program.

Each time a quality check is completed, the Quality Checker records the outcome in QST.

A system-generated email is sent in real time to the Service Officer and their Team Leader advising them of the quality check outcome.

Individual results are captured in QST.

Quality checking feedback is sent by email to the Service Officer and their Team Leader. The email includes details about the:

• check
• result (including any errors identified)
• quality checking dispute process

Method for managing and storing feedback

Feedback is sent to individual Service Officers and Team Leaders by an email. Feedback data is recorded/stored in QST.

Critical errors and Non-critical errors

Service Officer must correct critical errors immediately as per the feedback email.

Note: for My Health Record errors, Quality checkers must:

• complete the MHR error email template, and
• send the completed template to the My Health Record Support team for action

Enquiries

Quality Checkers must contact a Local Peer Support (LPS) for any technical enquires.

Enquires about quality checking process or issues with checking results that cannot be resolved should be directed to Quality Operations & Technical Support by email.

Quality checking procedures are reviewed and updated by the business and program in consultation with Quality Operations & Technical Support. The review will make sure that error codes are current and approved policy changes are included.

Any changes that need immediate action will be advised and updated accordingly. Any changes not critical to quality will be incorporated in the review of the procedures.