QA for Development of the Prioritized Problem List

7.1.2.7.2 - QA for Development of the Prioritized Problem List (Rev. 599, Issued: 06-26-15, Effective: 12-07-15, Implementation: 12-07-15) The MAC shall list the data and the metrics used to determine and verify each identified prioritized problem. That is, each identified prioritized problem shall have an explanation of current data and other information used to support the decisions to include the problem and assign its priority. The QA process shall ensure that MR activities and improper payment interventions are not dedicated to problems that are consistently overturned on appeal, based on outdated data analysis, or the focus of other operational areas of the MAC with similar goals. The QA shall be performed for each intervention that checks for effectiveness and progress towards the specified goal. The QA component shall include a projected goal, a timeline to achieve the goal, and an element to assess effectiveness of the intervention and progress towards the stated goal. The QA component shall include a determination of whether the problem has been resolved or partially met, or whether a more progressive course of action is required. The MAC shall evaluate the effectiveness of edits and the priority status of the problem. An effective QA process shall also include periodic meetings with other operational areas, such as POE.