Compliance/Hotline Report

Required Field (*)

“Hotline Report” means a report made either online to Backpack Medical Group PC, Compliance Hotline system. The hotline offers a reporting mechanism for employees to express concerns, ask questions, and offer ideas related to Backpack Medical Group PC’s Code of Conduct, policies, procedures and work practices.  The hotline is available 24 hours a day, 7 days a week on www.hellobackpack.com/make-a-report. To submit an online report, a reporter would go to the website and select the “Make a Report” link on the page and complete the form.

“Occurrence” means any event involving a patient, client, member or visitor that is not consistent with routine care/service to the patient/client or routine operation of the clinic.  Examples of an occurrence may include but are not limited to: falls, treatment concerns, deviation from established procedures for treating patients, suspected injury or harm, and adverse outcomes.

A concern related to a clinician may be reported using one of the following procedures:

• Completion of Occurrence Report
• Filing a Hotline Report
• Report to any one of the Credentialing, Compliance Manager, Billing / Payer Relations, Care Coordination, or Human Resources departments
• Report to Operations or Executive leadership

Compliance and Human Resources will review all reports, conduct an initial investigation and determine if additional action(s)  are warranted  by the Peer Review Committee.

Examples of circumstances that may be appropriate for peer review include but are not limited to:

• Any aggregate or individual information derived from incident reports, outcome reports, patient complaints, licensure action, complaints from third party agencies or other sources of information(including internal on-going review)  that suggest deviation(s) from acceptable standards or patient care, regulatory requirements or other Backpack Medical Group PC policies
• Performance of clinical treatment that falls outside the boundaries of documented competencies
• Potential clinical quality issues raised by another clinician, third party payor, or referring clinician
• Patient harm (or a near miss of harm) that was caused by treatment by the clinician

Name

Email

Subject of Report *

Make a Report  *

Compliance and Human Resources will review all reports, conduct an initial investigation and determine if additional action(s) are warranted by the Peer Review Committee. Backpack Medical Group PC Standards of patient care performed by the Compliance Department and/or their designee

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