NCQA Requirements: The Nine Most FAQs

Yes, as a URAC accredited nurse call center, Fonemed meets NCQA requirements in a couple of key respects. We offer wellness and prevention programs complemented by a health information line that is staffed by licensed nurses or clinicians in the state where they provide service. In fact, our nurses and clinical staff are available 24 hours’ a day, 365 days a year.

We are very serious about PHI, and view patient privacy as an essential component of our clinical services. We deal with this matter on two fronts, both from the perspective of personnel and technology. Our organization secures Business Associate Agreements (BAA) with all clients who receive call reports to assure that HIPAA/HITECH requirements are followed to the letter. Furthermore, all of our nurses receive a full package of HIPAA/HITECH compliant communications and information tools and operate under strictly controlled physical environments that conform to HIPAA, HITECH, OSHA standards. Our policies and performance standards clearly govern the provision of telephone advice and the scope of advice under which guidance is provided. Each of our calls are recorded, allowing for subsequent monitoring and review by our Quality Management Team. Finally, from the technology standpoint, Fonemed maintains all records and call recordings for a minimum of seven years securely as mandated by HIPAA/HITECH standards. All PHI and recordings are stored in a secure database combined with redundant off-site backups.

Over 99% of calls are live answered within 30 seconds of the person hearing the recorded disclaimer. If a Registered Nurse is not available, the call will be transferred to a Health Service Specialist (HSS). In this case, the Health Service Specialist will take the caller’s information and submit to the nurse for callback. Callers are then informed to expect a callback from a Registered Nurse (licensed within their State) within an average of thirty minutes, although most callbacks are completed within 20 minutes

No problem. Services are provided in English and Spanish at no additional cost. About 15% of our calls are in Spanish. Upon client request, callers requiring assistance in other languages can also be accommodated. Clients interested in other languages can benefit from our real-time interpreter services in these instances.

Absolutely. We produce a detailed encounter report following each triage call. These reports are then forwarded to the primary care physician or other HIPAA authorized entities via secure fax or a secure FTP site in XML, text or PDF or HL7 format. Our population health management platform facilitates outbound calling as well as 24/7 inbound triage and we do follow-up on specified cases and contact members when deemed medically appropriate. A member’s personal health record is always available to us and includes prior contact history.

Since we developed our software we can report on virtually anything our clients are interested in. Typically, our client’s are interested in: 1.) Real-time encounter reports that are generated after each call, 2.) Aggregated Monthly/Yearly Reporting, and 3.) Complete monthly call lists. These are just a few of the most common types of reports requested.

This is totally up to the client, but here are few that are quite common.

• Percentage of Calls that Required Triage
• Average Triage Call Time
• Abandonment Rate
• Average Speed to Answer
• Highest Proportion of Calls by Age of Patient
• Most Calls by Day
• Most Calls by Hour
• Most Frequent Final Disposition

NCQA expects that a health information line is evaluated at least once per year. We go a few steps further by constantly measuring performance and routinely calling back up to 5% of callers for quality assurance purposes.

Yes, they are, and so are we. In fact, our Quality Management (QM) Program is structured to ensure the proper credentialing, orientation, training, monitoring, supervision, and evaluation of clinical and non-clinical staff as well as the service provided. In addition to periodic call monitoring/auditing and benchmark reviews, we have established a number of initiatives to ensure our priorities for improvement are consistently met. These take many forms and often include: clinical in-service training sessions, professional development seminars, and other continuing education programs for our staff. We are always striving to improve our culture of life-long learners and dedicated care-givers.