Our clinical staff has a combined clinical experience in excess of 40 years. This clinical experience spans the entire life spectrum, as well as, a vast and diverse cross section of nursing. The clinical experience includes, but is not limited to Woman’s Health and Obstetrics, ICU, Acute Care, Telemetry, Medical Surgical, Geriatric, Home Health, Local Care Coordinator, Surgical, and, PACU. Our clinical staff has an average of 8-10 years of reviewing medical charts. Our clinical staff has experience with ICD-9, CPT coding, HCPCS codes, InterQual, concurrent and retro reviews. Our clinical team regularly makes use of inter-rater reliability both prior to the execution of validations and randomly during validation.
We hire only experienced nurses with diverse and extensive clinical backgrounds. During our recruitment process we offer various validation scenarios to include roadblocks that may arise and ask each perspective clinical reviewer to give detailed answers to how he/she would handle those situations. We seek individuals that are confident, and, well spoken with excellent customer service skills. Our goal is to create an inclusive team environment where each member strives to be the best they can for the team as a whole. We believe that when our clinical team feels a sense of ownership of the project, our customer receives exemplary results. Additionally, we seek individuals that think creatively, and, offer solutions rather problems. Production standards for our clinical staff are reasonable yet high. We expect each team member to work towards the project goal in earnest. We hold daily nursing huddles to go over the individual and team goals for the day. We also discuss the current state of the project, short & long term goals, process improvements, and seek to fill in any needs any particular team member has to ensure success as a whole.
Prior to the start of PSV, our clinical team develops Required Documents for each measure to be validated. This is in an effort to ensure that each member of our clinical team is on the same page with regards to the intent of the measure, as well as, which documents from the medical would be required to show proof of meeting the performance of the measure. These documents are then vetted with CMS, NCQA, and our Medical Director. Our clinical team also runs mock validations with at least 3 nurses validating the same measure against the same patient chart. This validation is done independent of one another. After each respective nurse has completed her validation, the clinical team joins a nursing huddle in which results are critiqued to ensure that each nurse has validated the charts with the same outcome and rationale for doing so. In addition, during the execution of PSV, 2 clinical team members review every chart regardless of whether the first clinical reviewer passed all the charts. In the event that a chart fails either one of the first reviewers, the chart is escalated to our Medical Director. Additionally, if there continues to be any ambiguity with regards to the outcome of the validation, the issue is escalated to CMS for clarity.