URAC Accreditation Tips

URAC has been keeping track of what issues in the Core module are missed most frequently by URAC applicants. It is using the results of this tracking process to inform its monitoring onsite reviews. In this blog, I'll review these frequently missed standards in the Core module.

Core 6a: Verification of licensure and certifications. There is a growth in the practice of selling licenses, so scrutiny of this area is increasingly important. There are particularly common problems around relicensure and recertification.

Core 7h: All training not documented. What's frequently missed here is documentation of medical staff training.

Core 9: Medical Staff audited documentation. Annual performance evaluation documentation has been frequently found to be missing.

Core 13a: Data integrity. See my blog on this here. Reviewers are asking applicants to run various reports, then are checking on the accuracy of those reports.

Core 13c: Improvement plan from disaster recovery testing. The problem here often is a lack of documentation of how the applicant tested its disaster recovery plan, or the lack of a plan for preventing reoccurrence of problems identified in that testing. One issue: some companies have moved to scanning companies for appeals; the problem comes in where the scanning company doesn't record the date it receives the appeal. This is a data integrity problem.

Core 13d: Method for destruction of paper records. The organization will sometimes forget about the paper records that served as the basis for entry of information into its electronic data system. This standard requires the implementation of a plan for the destruction of such papers.

Core 14 Business Relationships: You must have written agreements describing the services to be provided. For example, if all you have is a UM contract, but you're seeking DM accreditation (and the contract with clients doesn't mention DM), it may raise some issues.

Core 17 g&h: Sub-delegation. For years, this has been one of the most frequently missed standards. Read the standards carefully, check out my blog entry on delegation here, and make sure you have a process for newly executed delegation agreements that assures that they'll comply with Core 17.

Core 27: Maintains a system for complaints. Be sure that your system captures all incoming complaints, and that your method of handling such complaints is integrated and provides appropriate appellate mechanisms where required. The key to this standard is timeliness of response and the method for informing consumers of the right to complain and appeal. The reviewers pull 5 complaints, and will be looking to see if you follow your own procedure in response to complaints.

Core 29: Reporting of aggregate complaints to QMC. About 3 years ago, URAC built in a series of requirements throughout its standards requiring the submission of various reports and performance evaluations to the quality management committee (QMC). Make sure all of these reports not only are reported to the QMC, but that the minutes of the QMC reflect receipt and consideration of those reports. This problem comes up often with networks that don't track or report complaints.

Of course, the reviewer conducting your monitoring onsite will look at other standards (most notably, all of the standards weighted 5 and 4), but you'd better have your act together for the standards I've listed here.