URAC Scoring

Once upon a time, URAC standards were of two flavors: "shalls", with which applicants had to comply in their entirety, and "shoulds", of which applicants had to pass only 60%.

This scoring system went out the window three years ago, to be replaced by the current numerical scoring system. The new system is designed to provide a finer-grained understanding of two things: (1) the relative importance of the various standards and (2) varying levels of compliance with a particular standard by an applicant. Here's how the new system tackles these two issues:

The Relative Importance of the Standards, a.k.a., "Weighting"

The URAC Standards Committee has assigned a weight to each standard, on a scale of 2 through 5. Standards weighted "5" are known as "mandatory standards". More on that later. Typically, standards weighted 4 and 5 are more likely to relate to patient safety than are lower weighted standards.

Levels of Compliance

In the old system, an applicant either passed or failed a standard -- a harsh, binary system. Under the new system, the URAC reviewer makes an assessment as to how completely an applicant complies with a standard, measured on a 0-to-4 scale. If you ace a standard, you get a 4; if you blow it completely, you get a zero.

There are guidelines that help reviewers determine what score to assign for an applicant's compliance with a particular standard. The key to understanding this system is to know that some elements of a standard might be designated as "primary", and the rest are "secondary". Simply put, it's really, really important to get all the primary elements right; if you don't, the highest score you can earn on a standard is a "1" out of a possible 4. On the other hand, missing a secondary element is less catastrophic, resulting, typically, in a 1-point deduction.

Combining the Two Dimensions

These two dimensions come together through multiplication: to get a total score for a standard, you simply multiply the weight times the reviewer's rating. Thus, if you ace a mandatory standard, you multiply your score against the weight of "5" to get a total score of 20.

Add 'em up and . . .

So, when you total up all the standards, what then? In order to achieve full accreditation, you need to achieve at least 94% of the possible points in both the Core module and each of any other modules under review (e.g., Health Network, Utilization Management). (Officially, this is just a guideline for the Accreditation Committee, which is not bound by the scoring system, but it's a good guideline that is almost always followed).

If you score less than 94%, but at least 90%, you have a shot at "conditional" accreditation. Most states consider this accreditation, but you'll probably have a follow-up visit in 3-6 months to verify that you've fixed the problem. The other problem with "conditional" is that it is listed on the URAC as "conditional" -- a change from previous URAC policy.

What about the mandatory standards?

In addition to achieving the minimums under the above scoring system, an applicant also must score at least a "2" on every mandatory standard. Miss one, you get "conditional" accreditation; miss two, and you are thrown into "corrective action", irrespective of the numerical score.

So, does this mean I can pick and choose what to comply with?

Not really. We never recommend anything other than trying to score 100% of the possible points. Our reasoning is that few applicants can know all the possible losses of points. If you try to guess that you'll be perfect over here, and therefore can choose to lose points over there, you're asking for trouble.

Don't count your money when your sittin' at the table . . .

So, as is so often true in life, do the best you can in all areas, and let the scoring take care of itself.