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BRRR Q&A

Briefings on Outpatient Rehab: Reimbursement and Regulations, March 1, 2009

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Question: We are negotiating a managed care contract and have been asked to fill out a questionnaire and answer questions, but we are not sure of the significance of these questions. The managed care contract is asking whether we require continuing education, whether we have a quality assurance committee and, if so, how often it meets, and whether we have a formal patient grievance/resolution procedure.

Answer: Questions of this sort generally indicate the managed care plan is ensuring that its contracted providers have in place procedures that support the accreditation standards for managed care plans. Prior to answering each question, review your formal policies and procedures to determine whether you have the policies asked about in the managed care questionnaire. In some instances, you may not have a formal policy and procedure, but rather an informal or implied process. Your facility may not have a formal policy on continuing education but, for example, if therapist licensure is required in your state and its renewal requires completion of continuing education units and if you require therapists to maintain a license, then, by definition, you require continuing education. It would be beneficial to identify this as a policy, separate from a job description.

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