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ResMed Help Center

***QA Quick Reminders

 

Topics List:

 

January 15, 2018

  • Starting February 1, 2019 Nader and Rosemary will begin to monitor and complete Quality Assurance Scorecards on emails and voicemails. You can review the complete document at the following link: Microsoft Teams>General>Files>QA Scorecard Details Email & Voicemail VER 1.0. Below are some of the sections you will want to pay special attention to.
    • Verified Patient Information (15%)
      • Verified the patient's name, phone number, e-mail and/or address matches the one on the account. If not able to verify, e-mailed the patient requesting them to verify.
      • Ensures the correct account is linked to the case in Salesforce
      • This includes, but is not limited to, any differences between duplicate accounts created by web registrations.
    • PHI Handling (15%)
      • Was PHI handled correctly to avoid breaching patient privacy and/or over exposing PHI?
        • Used correct MRN, when available
        • Used month/day of birth when MRN is not available
        • Used correct patient name when responding to the patient directly
        • Did not include any demographic/insurance details

If you do not properly verify or breach PHI... 

you will not earn any points for the rest of your call. This will be considered a Fail and will significantly affect your QA averages for your monthly stats, as well as your shift bid ranking. This is to ensure we are properly verifying accounts as per HIPAA/PHI guidelines.

  • Use Provided/Appropriate Template (15%)
    • Used appropriate template for situation from Salesforce, or appropriately worded template if no provided template suits the situation.
      • Include all appropriate documentation in ONE communication (e-mail or callback task)
      • Used appropriate wording when no provided template suited the situation
      • Ensured correct header/footer used in e-mail template

January 14, 2018

  • Accepting emails, assigning your emails to yourself, and disconnecting emails when completed, this includes voicemails. We have been noticing some trends with the following points. If you are not completing emails/voicemails by following the guidelines below, this could be viewed as work avoidance.
    • You must click Pick Up when you receive an email, the same way you accept a call.
    • When you receive an email, you must remember to change the Case Owner to yourself right away. This will ensure that you will not lose the case if you accidently close the tab prior or completing the email. If you pick up an email, and close the tab before you assign it to yourself, you can reach out to Tammy or Nader and we will look up the case number for you. When you close the tab and do not complete the email, it will not regenerate and assign to the next CSR. It basically sits in limbo until we run our daily checks and then the case will be manually assigned to you. 
    • In order to ensure we are working thru emails/voicemails in a timely manner, when you have completed an email you must disconnect it from ININ/Salesforce Phone to allow for another email to be assigned to you. This includes disconnecting voicemails once you have changed Case Owner to yourself. We provide time during the day to complete voicemails/patient follow up; therefore, when you receive a voicemail you must change the ownership to yourself and disconnect from ININ/Salesforce phone.

If you are not completing emails/voicemails by following these guidelines, it could be viewed as work avoidance.

  •  Completing Transfers to HME
    • When we are transferring the patient to the HME, once we have connected the patient with someone you must remember to complete the transfer in order to disconnect the call. If you do not complete the transfer to disconnect the call, this could lead to a PHI breach as the HME may ask for, or the patient may provide, additional details which we are not subject to know/receive. Do not hang on the line - disconnect the call promptly.
  • Choosing correct Support Offering for Salesforce cases. The correct Support Offering should be chosen based on the following:
    • RRS 1.0 – Used for calls when the patient is found in ReSupply 1.0, except when the patient has an LCT protocol
    • RRS 2.0 – Used for calls when the patient is found in ReSupply 2.0 (Refresh)
    • Live Transfer – Used for calls when the patient has an LCT protocol

January 4, 2018

  • In order to continue driving the best service possible to our patients, and keep us aligned with the constant changing business needs, we have developed a new QA Form which will be effective February 1, 2019. The changes below and attached a new copy of the QA Scorecard Details (Ver 3.0). This document can also be located on Teams > Resupply Team > General > Files > QA Scorecard Details - VER 3.0.
    • Know Me - Verify Patient Name/DOB (18.18%)
      • Ask the caller to verify the Full Name and Date of Birth (including year) on the account, ensuring the information provided matches the information on file. 
      • If the patient refuses to verify Date of Birth, we MUST verify the Full Street Address. Zip Code only does not meet the HIPAA/PHI guidelines.
    • Process and Procedure - PHI Handling (18.18%)
      • Was PHI handled appropriately to avoid breaching patient privacy and/or over exposing PHI?
      • Ensure you are not including any patient details such as phone number, address, year of birth or other details via phone or written communications to HME/patient.

If you do not properly authenticate or breach PHI... 

you will not earn any points for the rest of your call. This will be considered a Fail and will significantly affect your QA averages for your monthly stats, as well as your shift bid ranking. This is to ensure we are properly verifying accounts as per HIPAA/PHI guidelines.

  • Soft Skills - Engaged in a meaningful conversation with the caller (9.09%)
    • Do not used scripted wording, use more open-ended questions for Wellness Check
    • Use 1-2 rebuttals for declined sales, when appropriate.
  • Process and Procedure – Create a Salesforce Case (18.18%)
    • Salesforce case is created with the appropriate categorization and meaningful subject line.
      • Case created, categorized correctly and used a meaningful subject line (Full)
      • Case created (Half)
      • No Salesforce case (0)
    • For more information on creating cases, see this article.

August 1, 2018 (Original Posting Date)

  • When a patient calls to make changes to recently placed supply request, do not reset the active outreach window and place a new supply request. Send the appropriate communication (for either changing or removing/adding an item) to the HME. Placing multiple supply requests can create a lot of confusion for the HME and the patient. In many cases the HME will simply cancel all the supply requests or they will only process the first/last supply request they receive, resulting in patients not getting the items they wanted/needed.
  • We have all had calls where the patient has said "No" to being on therapy in when they are actually still using their equipment. When this happens, we must ensure the patient’s account Status is changed back to None prior to resetting the active outreach window and completing it. From the Demographics tab, be sure the Status is change from Not On Therapy to None and click Save. Then, go back to List Patients, reset the active outreach window and complete it with the patient. This will ensure the wellness check will be set to the correct outreach date based on the patient’s supply needs and proper outreach window. 
  • When calling patients directly in response to voice mails or for any other reason, we must remember to identify who we are and ensure the person you speak with confirm the date of birth on file. 
  • Remember to double check when sending communications to an HME to see if they use callback tasks or emails. Article here.

April 23, 2018 (Original Posting Date)

  • For patients that have temporary addresses, it is still required to change their address in the Demographics tab in ReSupply. If the address is not changed in on the account, it will not show up in the required reports for the fulfillment team. Even if we send an email/task to the HME, we cannot guarantee it will be received/processed prior to the order shipping. If the patient indicates their new address is a temporary address, advise them that they will have to change their address back to their permanent address when they place their next order. This is a great reason why we now document the old/new address information into an Add Other Task. A good habit to get into when verifying the patient's address, is asking “Is your address still _________?” The current address can be found by pulling the patient profile up in SalesForce

  • Remember to close your created tasks if they are not Callback Tasks for the HME or Auto Tasks created for orders/address/insurance changes etc. Article here

  • When you speak to someone on the phone that is not the patient, you must select BAD NUMBER in the Tasks tab, which will note in the system that this is not the correct phone number for the patient. We also need to create a Patient Note indicating the wrong number and send an e-mail to the HME using the Bad Number template. Article here

  • Please remember that we need to be asking the patients to verify their name and date of birth on the account now. This is to stay compliant with HIPAA in asking the patient to verify two pieces of personal information. If the patient is unwilling to provide their date of birth, then we can accept the street address on the account (not just City/State).

  • Before ending your call remember to check to make sure the patient's e-mail address is up to date. The e-mail address can be found on the patient's Demographics tab. If the patient does not have an e-mail address or does not want to provide one, make sure you document this as an Add Other Task note.

April 16, 2018 (Original Posting Date) 

  • When completing web registration emails, please ensure you are matching the patient details in the original account to the new information the patient has entered into their duplicate account. IE: phone numbers, you should be adding the phone number from the original account as a patient note (Secondary # 1234567890) and updating the number to the phone number listed in the web registration. This will eliminate further issues with the patient trying to log into the original account. Article here

When determining if an account is a duplicate, we need to be able to match enough information to ensure the account is in fact, a duplicate. If the patient's first and last name, along with either their date of birth or address match, then we can safely proceed as if the account was verified. If we are not able to match this information, we should request the patient contact us using the Forgotten Password/Login Info template.

  • When creating new patient accounts, it is required to create a case is Salesforce. We also need to make sure to link the case to the correct HME, including the patient's name and phone number in the description field. Article here.
  • When creating your case in Salesforce, be sure you are using the correct category. Your Category should match what drove the patient to connect with us.
  • Remember to note the name of the person you spoke with if you were not speaking with the patient. This is important to have if the patient calls back to inquire on why supplies were requested, etc. we can then advise who we spoke with on their behalf. This should be captured as a Patient Note as well as an Add Other Task.

 April 9, 2018 (Original Posting Date)

  • If updating patient insurance or demographic details while completing a patient wellness check, remember that if an Alert or an Open Task is created you will not need to send an email to (or create a call back task for) the HME. If no Alert or an Open Task is created, we must advise the HME of the change by sending an email or creating a Callback Task (for task based accounts). Article can be found here.
  • When completing wellness checks with patients, please ensure you are clicking the next button all the way thru before closing the pop out screen. One way to ensure you completed the full wellness check is to ensure you no longer see the wheel or cog under List Patients. 1.0 Article here    2.0 Article here
  • When receiving an email, your first task should be to assign the case to yourself in Salesforce. This way if you accidently close out of the case, it will still show under My Open Cases. When you have completed an email case, be sure you change the Status to Closed or Closed – No Action, depending on which suits the situation. You should also be refreshing your Salesforce at least once per hour to check for any reopened email cases that need to be completed. Article here.
  • Instead of asking patients ‘Do you need to request any replacement supplies today?’ try saying something more like “How is your supply of disposable filters, cushions/pillows, etc.?’. This generally gives patients a better understanding that their CPAP supplies need to be replaced on a regular basis and opens up the window to be able to educate patients on the recommended resupply schedule. 
  • Remember, when dealing with fastrack accounts, if the patient needs a mask change, size change, special item request etc, you may ADD a Notes for Patients. Article here
  • For Task Only Accounts, you must use the Add Callback Task to leave notes for the HME. Using the other task options may cause the HME to miss important details as they generally do not run reports for these tasks. You may wish to refer to the attached word document for assisting with leaving Callback Tasks. Article here
  • Remember to document extra details/comments/conversations in ReSupply about therapy/equipment concerns or any added details as to why they may not need supplies at this time. Also, be sure to note address and/or insurance changes (IE: Insurance change – old insurance to new insurance). Documenting the new demographic/insurance information is important in order to assist the HMEs with identifying which information is correct for the patient. 
  • When a patient has concerns regarding previous supply requests not being received, always check the timeline for important information that may help determine the cause. If a supply request has been placed within the last 1-2 months, you may want to reach out to the HME, before completing a new request, to ensure there are no issues with the patient account delaying supply shipments, such as outdated insurance/prescriptions.