Compliance and Performance Improvement (CPI) Committee Organizational Chart Board Clincal CEO CPI Program CPI Committee QA/Compliance* CMO Clinical Quality Operations Privacy/HIPAA Information Dental Human Resources Behavioral Health Finance QA Committee Professional Medical Review Board QI Committee *designates CPI Coordinator
Expertise Area Operations Finances Medical/Clinical Representative(s) Title Program Operations Administrator Corporate Billing/Coding Chief Medical Officer Representative Name(s) Diane Molina Vishal Kinra Bobby Hubley Dr. Adil Nicowala Responsibility and Roles within CPI Committee Responsible for CPI program effectiveness Develop, support, and operate the QM plan Actively addresses and reports on any corporatelevel issues relating to quality and patient safety Effectively communicate QA/QI activities as appropriate to clinic/practice managers Actively addresses and reports on any corporatelevel financial issues relating to quality and patient safety Develop, support, and operate the QM plan Insurance billing audits Identify providers who successfully qualify for EHR incentive program payments Work to meet Section 330 requirements Track revenues and expenses against the FQHC operating budget Provide for timely billing and collections Use fund accounting model and have internal controls Accountable to the Clinical CEO for the quality and safety of the clinical program, performance of provider staff, and provider performance assessment/improvement component of quality management program Keeps the Board advised through a summary of the activity of the program, reporting particular matters under development or resolved by the CPI Program and deemed appropriate for Board information or action on a monthly basis. Reports on a regular basis to the Executive Director, CPI or Professional Review Committee, then directly to the Board on review, recommended action, policy and procedure updates, and the success of the CPI Program 2
Dental Dental Director Dr. Olusegun Alonge Compliance QA/Compliance* Judy Greer itself. (Monthly written reports to the Board and quarterly in person appearance at board meeting) Conducts professional review Participates in the credentialing process concerning credentials and privileges for the scope of practice of clinical staff and makes recommendations regarding privileges of licensed and certified health care professionals at the center through the credentialing function of the CPI Program. Determine aspects of the dental clinics that needs to be monitored Establish the standards by which to evaluate those aspects Assist in the collection, compilation and use of data to make improvements to the organization Accountable to their supervisors and the Executive Director for monitoring the compliance, quality and safety of services and functions of the dental clinics Report issues to the CPI Officer and to take appropriate actions Identify opportunities for improvement and promoting options for continual performance improvement Monitor health center process Provide audit reports of risk areas to ensure compliance with legal requirements A periodic audit of claims submitted and the underlying coding and billing practice Ensure that the risk areas, set forth in the Physician Practice Guidance, are paid attention to when conducting audits of the claims submission practices and related written policies and procedure Responsible for maintaining all QM plan 3
Environment of Care Human Resources Practice Management HIPAA Privacy Information Behavioral Health Clinical Quality Administrator of Human Resources Practice Management Information Behavioral Health Director Crystal Leo Debra Makowsky Vanessa Daily Brian Thurston Donna Hilbig documentation (meeting minutes, PDSAs, QA reports, QI activities, etc) Report to CPI Committee on Quality Improvement processes and updates Responsible to drive the QI process for clinical measures and gather documentation Responsible for maintaining QI documentation and records Report on OSHA, Safety, Infection Control, and Medical Equipment Management incidents and observations Submits names of employees due for recredentialing and/or credentialing to CPI committee and CPIC Coordinator Audits credentialing files and submits reports to CPI committee and CPIC Coordinator Maintains documentation of staff training, skill assessments, CPR certification, CMEs, etc Coordinates training for quality/performance improvement per recommendation of Quality Improvement Committees Eligibility review and audits Cash/copay per DSHS standards Maintain compliance with HIPAA Billing record audits Maintain compliance with HIPAA security, concerning IT Actively addresses and reports on any IT issues relating to quality and patient safety Assist, lead, and/or take part in HIPAA compliance audits Determine aspects of the behavioral health department, staff and providers that needs to be monitored Establish the standards by which to evaluate 4
*CPI Coordinator those aspects Assist in the collection, compilation and use of data to make improvements to the organization Accountable to their supervisors and the Executive Director for monitoring the compliance, quality and safety of services and functions of the behavioral health department, staff and providers Report issues to the CPI Officer and to take appropriate actions Identify opportunities for improvement and promoting options for continual performance improvement 5