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Rules-Driven Authorization in Home Health: Integrated Care Management & Quality Improvement

Learn about the Home Health RDA questionnaire for better care management and quality improvement. Presented to home health providers on April 9, 2014, this session by Valerie Miller, Jacqueline Shipp, and Tiffany Brooks highlights the benefits of rules-driven authorization in streamlining processes for improved provider satisfaction and clinical focus.

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Rules-Driven Authorization in Home Health: Integrated Care Management & Quality Improvement

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  1. INTEGRATED CARE MANAGEMENT AND QUALITY IMPROVEMENT Home Health RDA Questionnaire Presented To: Home Health Providers April 9, 2014 Presented By: Valerie Miller, Jacqueline Shipp, Tiffany Brooks

  2. Rules Driven Authorization • Benefits all parties • Quicker turnaround • Minimizes need for changes to providers’ processes • Increased satisfaction of providers • Allows reviewers to focus on cases which truly need hands-on clinical attention 2

  3. Home Health Questionnaire When initiating the Home Health questionnaire, you will see the question “Are you requesting an evaluation?” Answering “Yes” leads to the question “Is there a Physician’s order signed and dated by the Physician for the evaluation?” The second question is “Are you requesting home health visits?” When you answer “Yes”, this will open up a series of questions requiring answers in order to complete the questionnaire. Examples follow in the next five slides. All questions require answers in order to obtain RDA approval Concurrent reviews are not authorized by RDA 3

  4. Question Samples: • Drop Down Menus on select questions:

  5. Question samples: • B-12 injections

  6. Question samples • Speech/Swallowing Therapy:

  7. Question samples • Skilled Nursing question:

  8. Question samples • Indwelling catheters:

  9. Home Health RDA • If you have any questions or concerns regarding the RDA process, please contact KEPRO at 1-888-827-2884

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