Chapter 22: QA Center
Chapter Overview
What You'll Learn:
- QA Center stats and queue
- How to Approve & Finalize
- What happens with physician signature and automated fax/SMS
- How to Confirm physician signature
- Return for correction / remove
Path: Sidebar → Clinical → QA Center → /dashboard/qa
Text-only.
22.1 What You See
- Title: QA Center
- Link/section for Removed documents
- Section: Documents Queue (one table — no tabs)
Stats cards:
- All Pending Items
- Pending Review
- Pending Signature
- High Priority
- OASIS Pending
- Notes Pending
- Avg. Approval Time
Queue filters (above the table): Search (patient name) · Visit date · Document Type · Status · Queue (All / Priority only / Overdue only) · Alerts.
The queue lists documents in Pending Review or Awaiting physician signature (shown in the UI; database may still say Pending Physician Signature). Row action: Review.
22.2 Approve a Document
- Open an item from the queue (Review).
- Click Approve → modal Approve & Finalize.
- Confirm with Confirm Approval.
Effects (SOC / ROC / Recert and similar)
- Care Order becomes Active (operations unlock) with PA / HIPPS / POC side-effects as configured
- Document moves to awaiting physician signature (attention — does not keep the episode non-Active)
- For OASIS types that require MD signature (SOC, Recertification, ROC — and Non-OASIS SOC/Recert when on that track): Betasky schedules physician signature automation after approve
- Transfer / Transfer Discharge / Discharge / Death / routine notes that do not need MD signature go straight to Approved (no auto physician fax)
Does Approve send a fax to the physician?
Yes — when Communications automation is available for the agency, Approve & Finalize for signature-required assessments queues an automated physician signature fax (and often an SMS nudge). Staff do not have to open Communications and click Send fax for the first send.
Automation runs only when:
- Agency is not sandbox (sandbox blocks Communications automation)
- Agency Communications is ACTIVE
- Physician signature fax / SMS notification types are Enabled or Mandatory (see Chapter 9 → Fax Notifications / SMS Notifications)
- Physician has a usable fax number (and phone for SMS) on file
If Communications is inactive, the fax type is Disabled, sandbox, or the physician has no fax number, the document can still show Awaiting physician signature, but the auto-fax may be skipped. In that case use manual Send fax from Care Order / Patient → Communications (Chapter 9).
Resend / first manual send: Patient or Care Order → Communications → Send fax. That is the supported path.
Common misconception: “Approve only sets attention — it never faxes.” Wrong. Attention and automated fax/SMS are both part of the post-approve physician-signature flow when Communications is configured.
22.3 Confirm Physician Signature
When the chart shows Awaiting physician signature (DB may still say Pending Physician Signature):
- Use Confirm physician signature.
- Confirm with Confirm signature.
This clears the attention state when the signed return is verified (for example after the faxed packet comes back signed).
QA may still edit under awaiting-signature in current product rules — it is not a full lockout.
Episode activation already ran on Approve & Finalize — Confirm signature does not re-run the full Active / PA / HIPPS activation.
22.4 Other Actions
| Action | Purpose |
|---|---|
| QA Review | Open review UI |
| Return for Correction | Send back to clinician (appears on My Schedules Action Items as Returned Note) |
| Remove | Remove from active QA handling per product rules |
22.5 Soft Alerts Reminder
Soft-alert IDs are non-blocking clinical plausibility items on OASIS — not automatically “CMS Fatal.” Use Check for Errors for submission validation (Chapter 21, Chapter 23).
22.6 Common Mistakes
- Thinking Approve never faxes the physician — it does queue auto fax/SMS when Communications automation is on (not in sandbox).
- Thinking the episode stays inactive until MD signs — after Approve, Care Order is typically Active with signature as attention.
- Expecting Confirm physician signature to create PA / HIPPS — that already ran on Approve.
- Looking for QA “tabs” — the queue is one table with filters.
- Expecting Transfer / Discharge / Death Approve to fax the physician — those types do not require MD signature and do not auto-fax.
22.7 Quick Checklist
- Pending Review worked down
- Approve & Finalize understood (Active + signature attention + automated fax/SMS when Communications is on)
- Fax Notifications / physician fax number checked if auto-fax does not go out
- Pending Signature confirmed when wet ink / e-sign returns
- Returned notes tracked via Action Items