Medicare Entitlement Statement (MES) quality checking in QST 111-22112508

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

The quality checking process:

• helps Team Leaders and Quality Checkers to identify process improvements
• ensures consistency in quality checking

See Resources for a link to the Enterprise Quality Framework.

The Service Delivery Support team is responsible for:

• analysing national quality reports to identify learning needs or process improvement opportunities
• escalating national quality issues to the relevant program or policy area and/or to the Quality, Performance and Technical Support team
• reviewing and updating the relevant Operational Blueprint (OB) files and training materials
• reviewing suggestions and working collaboratively with the Quality, Performance and Technical Support team to improve OB quality checking process and resources
• identifying strategic and operational risks or issues that impact customer outcomes

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 QST by sending an email to the Quality, Performance and Technical Support team
• timely error feedback is discussed with Service Officer as part of the coaching conversation to support any learning and development opportunities
• errors are analysed. 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
• Updating 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 (where applicable) when providing feedback

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

Quality Team is responsible for:

• Providing support for quality checking in the QST
• Providing relevant reports as required
• 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

Quality Checking accreditation must be renewed annually.

See Quality checker accreditation for more information.

Pre-checks

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

Programme/Post-checks

Programme/Post-checking randomly selects work completed the previous business day in Processing and National Demand Allocation (PaNDA). The results are provided to management and external stakeholders as needed.

Targeted Checks

Targeted checks apply to 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 re-checking 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 the Quality, Performance and Technical Support team with the:

• staff member’s details, and
• reason and length of time needed for the targeted check

Pre-checks

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

Programme/Post-checks

Between 0.1-1% of the monthly total of the below MES PaNDA work types are randomly selected for quality checking:

• MES
• RHCA

Targeted Checks

Discuss Targeted Checks with the Quality, Performance and Technical Support team.

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)
• QST
• Skill tags added on the QST

For the purpose of quality checking, an error is information processed/keyed into the system which does not match:

• the documentation 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.

Feedback is recorded/stored in the Quality & Support Tool.

Critical errors and Non-critical errors

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

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 on site should be directed by email to the Quality, Performance and Technical Support team.

Quality checking procedures are reviewed and updated by the business and program in consultation with to the Quality, Performance and Technical Support team. The review ensures error codes are current and approved policy changes are included.

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