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Quality checking dispute process for Medicare 111-23051519

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QBBI, QST and RMDS dispute tracker template Service Support Officer (SSO)

Do not share this attachment externally. See Freedom of Information – Information Publication Scheme.

A linked attachment is available for staff only (i.e. under IPS/FOI)QC dispute tracker template

For quality checking disputes about Quality Control System (QCS) information on the Medicare Quality Control System (QBBI), Quality and Support Tool (QST) and Report Management and Distribution System (RMDS).

QBBI, QST and RMDS email templates

Email templates used in the process for quality checking disputes about Quality Control System (QCS) information on the Medicare Quality Control System (QBBI), Quality and Support Tool (QST) and Report Management and Distribution System (RMDS).

Do not share these attachments externally. See Freedom of Information – Information Publication Scheme.

A linked attachment is available for staff only (i.e. under IPS/FOI)QC error dispute - Service Officer/Processing Operator send to Team Leader

A linked attachment is available for staff only (i.e. under IPS/FOI)Service Support Officer (SSO) QBBI/QST/RMDS QC reversal request

A linked attachment is available for staff only (i.e. under IPS/FOI)SSO QST/QBBI dispute unsuccessful

QOL and QMA Disputes page

For Aged Care (Customer) Quality On Line (QOL) and Quality Management Application (QMA) quality checking disputes.

QOL and QMA Disputes page

Request access to the QOL and QMA Disputes page

To request access to the QOL and QMA Disputes page including when staff details do not automatically populate.

For Service Officers 'general' or Service Support Officer (SSO) admin access - email the Quality and Skill Tags team and provide the following details:

  • Smart centre
  • Name
  • Logon
Frequently asked questions - QOL and QMA Disputes page

Table 1: these questions will help staff use the QOL and QMA Disputes page and track progress of the dispute.

Question

Answer

How do I determine the status of a QMA quality check?

The QMA Feedback tile in Process Direct shows all error codes and feedback from a QMA quality check. Results of the quality check will be available immediately after update by the QMO and may be subject to change.

Errors and feedback identified in a quality check where the final work item status is Cancelled/Withdrawn/Not Required or Not Effective are not included in accuracy calculations.

Do not lodge a dispute until the work item status is Completed.

What does the status mean?
  • New: this is the initial status of new disputes
  • Under review: a request has been assigned to an Independent Reviewer and is being reviewed
  • Under review pending advice/clarification: the Independent Reviewer is seeking advice/clarification
  • Awaiting reply: the Independent Reviewer is waiting for the original QOL checker's/QMO's right of reply
  • Reply received: the original QOL checker's/QMO's reply has been received
  • Escalated: the dispute has been referred to a program, policy team or Level 2 Helpdesk
  • Withdrawn: the dispute has been withdrawn
  • Finalised: the dispute has been finalised
What does the dispute outcome mean?
  • Pending: the dispute is still under review
  • Upheld: the Independent Reviewer agrees with original check result
  • Upheld for a different reason: the checking outcome is correct but for a different reason to the original decision
  • Overturned: the Independent Reviewer agrees with the dispute
  • Activity not located: the activity or Work Item was unable to be located
  • Insufficient evidence: insufficient evidence to support the QOL/QMA dispute has been provided
  • Non proficiency impacting error: the error/s do not affect overall accuracy and cannot be disputed
  • Withdrawn: the dispute has been withdrawn
How do I edit my dispute?

Staff can update a QOL/QMA dispute after it has been lodged.

Is the status of the dispute New?

  • Yes:
    • Select Edit. Open the QOL and QMA Dispute Form
    • Read and acknowledge the Privacy statement
    • Make the required updates
    • Scroll to the bottom of the form and select Update
  • No:
    • Select Edit. Open the QOL and QMA Dispute Form
    • Contact the Independent Reviewer to update the dispute
    • If the Independent Reviewer is not available, email Aged Care Customer team
How do I withdraw a dispute?

Staff can withdraw a QOL/QMA dispute after it has been lodged.

For the process, see the Process page > Table 3 > Step 5.

When will I be notified of the dispute outcome?

When the dispute is finalised, the staff member and their Team Leader receive an automated email.

Who is notified when the original checker's decision is overturned and the dispute is finalised?

An automated email is sent to:

  • the original checker
  • the staff member who lodged the dispute and their Team Leader
Who is notified when a dispute is referred to an independent reviewer?
  • An automated email is sent to the original checker
  • The staff member who lodged the dispute and their Team Leader receive an automated email when the dispute is finalised, including the response from the Independent Reviewer (if relevant)
Can I seek a further review if I disagree with QOL/QMA dispute decision?

No, when the QOL/QMA dispute decision is finalised, no further escalation steps are available.

How long does it take for finalised overturned decisions to update in SmartTools?

If the check was completed:

  • within the last 28 days - updated daily
  • between 29 to 90 days ago - updated weekly on the weekend
  • 91 or more days ago - SmartTools will not be updated
Staff members overturn does not appear in SmartTools. What can they do?

Follow up with the Team Leader to complete all basic troubleshooting before escalating further. This includes:

  • The SharePoint entry has a finalised status of Overturned
  • The Service Officer and QOL checker/QMO logon IDs are correct
  • Checking for any ongoing data matching issues in the SmartTools SharePoint
  • The date the activity was sampled or submitted matches the information in:
    • QOLCheck/QOLStat
    • Work Optimiser, and
    • the date of the returned activity in SmartTools
  • The Activity (AMR) number matches the QOL activity:
    • Example 1: AMR: 1234 (correct)
    • Example 2: AMR: amr 1234 (will not match)
  • The Work Item ID matches the QMA:
    • Example 1: Work Item ID: 12345678 (correct)
    • Example 2: Work Item ID: claim id 12345678 (will not match)
  • The correct benefit status is entered

If all of the above information matches correctly, email the Aged Care Customer team and confirm all above information is correct by including a 'snip' of all screens:

  • Smart Coach 'Daily' view
  • QOL tool or QMA feedback, and
  • SharePoint entry

QOL and QMA feedback templates

Table 2: this table contains templates to help Independent Reviewer Service Support Officers (SSO) in Quality On Line (QOL) and Quality Management Application (QMA) to provide feedback to Quality Checkers.

Type of feedback

Feedback text

Feedback included missing or incorrect resources to support the decision.

Choose the most appropriate text from the following (more than one may apply):

  • Incorrect and/or insufficient resources provided to support error/return
  • Resource should have been xxxxx
  • No resource quoted, should have been xxxxx
Explanation of the error and/or corrective action not sufficient.

Feedback did not clearly describe the error and/or corrective action taken/required.

Feedback not clear or inappropriate.

Feedback was difficult to understand or did not meet the Feedback Policy.


Staff Feedback Tool

Staff Feedback Tool

Contact details

Health Service Delivery Division - Program areas

Quality and Skill Tags

Medicare National Portfolio - Face to Face

Service Delivery Quality and Evaluation - team mailbox details