Quality in Every Aspect of MTM Business and Programs
As our mission statement reflects, our purpose and passion is Helping People Access Healthcare Through Quality Transportation Management. The word “healthcare” in our mission statement encompasses physical, behavioral, and social health, as MTM’s client base consists of transportation to a broad range of medical, behavioral, and human services programs. We understand, it is not just a ride. It is about providing safe, quality transportation with dignity to diverse populations who have specific, and sometimes specialized, needs. Our clients, transportation providers and passengers appreciate the high quality standards we have incorporated into our transportation programs.
The Quality Management Department (QM) oversees and monitors all aspects of MTM’s operations across all departments to ensure our clients, transportation providers, and passengers receive the highest quality of service achievable. The department’s activities include:
The QM Department oversees MTM’s formal Quality Management Program. We based our comprehensive QM Program on monitoring specific performance metrics and subsequent program improvements when needed. We derived performance standards on industry best practices, proven experience, and applicable National Committee for Quality Assurance (NCQA) standards.
Complaints and Grievances
High quality service is important to MTM and our clients. We have designed processes to address and resolve service issues to achieve a high level of passenger satisfaction. MTM’s QM Department responds with sensitivity and empathy to callers with a complaint or grievance.
The complaint and grievance process does not stop with the collection of information. Specially trained Quality Service Coordinators (QSC) take the call, document the issue, and then fully investigate each complaint to an acceptable resolution. As needed, the QSC provides education to the provider involved to prevent future complaints. If more intervention is required, MTM puts a Corrective Action Plan in place until the issue with the transportation provider is resolved. Implementing preventive measures completes the loop of the complaint and grievance process. The QM department ensures that both MTM staff and our transportation providers maintain quality service for our passengers. MTM maintains a passenger complaint rate of less than 2% across our book of business.
Educate, assess, prevent
We consider all complaints important and follow through to address the complaint, provide education where necessary, and prevent future occurrences.
To give our clients the best possible transportation programs, we monitor and report quality outcomes of all operational departments to our internal Quality Management Committee (QMC). We monitor key indicators by department to determine the efficiency and quality of the services we provide. Each indicator has a specific threshold; when reached, further evaluation and resolution strategies result.
By tracking and trending data, MTM can identify program successes as well as areas for process improvement. The QMC defines performance metrics based on NCQA standards, client protocols, and MTM’s proven best practices. The QMC then evaluates these metrics for workflow improvements. In addition, the QMC reviews department reports and provides quality oversight and direction unique to each department.
The QMC also consists of the following five sub-committees:
Operations Committee
Risk Management
Credentialing Committee
Appeals Committee
Advisory Committees
Provider Advisory Committee
Stakeholder Advisory Committee
Through these sub-committees, the QMC provides quality oversight on focused activities resulting in exceptional NET/NEMT management on behalf of our clients, members, transportation providers and other stakeholders.
The Quality Management Department conducts audits of trip sheets and transportation provider files to monitor compliance and accuracy, and to prevent or detect inappropriate activity. The QM also monitors the appropriate use of the transportation benefit through trip verification. The Quality Management Department contacts the medical facility or point of destination and verifies that the passenger actually attended the appointment. We randomly select 3% of all trips for all clients each month for trip verification. MTM is a watchdog of sorts, on behalf of our clients, for potential fraud and abuse of the transportation benefit. The Quality Management Department also conducts internal audits for process and HIPAA compliance.
Smart businesses anticipate, rather than react to fraud and misconduct. MTM safeguards against fraudulent activity and places high importance on maintaining a corporate culture of fraud and abuse detection and prevention.
MTM’s Quality Management Department will investigate reported or suspected fraud and abuse to determine if fraud or abuse exists. Internal audits serve as an additional filter for fraud and abuse as well as assess the effectiveness of MTM’s fraud and abuse prevention measures. Each employee and department is responsible to be ever watchful for the potential of fraud and abuse.
Along with conducting various audits and investigating fraud alerts, we designed our billing processes to ensure accuracy. We also monitor utilization reports to identify frequent users for possible abuse of the benefit.
MTM addresses fraud and abuse from all perspectives to ensure our clients receive the highest level of program integrity.
