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SOME MEDICARE ADVANTAGE PLANS WILL BE UNAVAILABLE

Three of VNSNY Choice Medicare advantage plans will not be available in 2019. Check here for information about 2018 Medicare plans

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How to Avoid an Extended Medical Record Audit Process 

SelectHealth is required to ensure participating Primary Care Providers’ medical records comply with health plan standards. To that end, each year VNS conducts audit of the records of randomly selected members. 

Providing complete records in the timeframe requested will eliminate the need to make repeated requests or to even come on site for a physical audit. 

CHOICE Quality Management uses 12 elements identified by the National Committee for Quality Assurance Guidelines as accepted standards for medical record documentation. 

They are listed below. 

  1. A) Identifying information of the member including member’s age, sex and date of birth
  2. B) Identification of all providers in the member’s care and information on services furnished by the providers
  3. C) Problem list or documentation including significant illness, medical and psychological conditions
  4. D) Presenting complaint(s)/Purpose of visit
  5. E) Prescribed medication, including dosages and dates of initial or refill prescriptions
  6. F) Allergies and any adverse reaction (or notation of known allergies or reaction)
  7. G) Information on advanced directives/documentation of discussion of advanced care planning with member and/or caregiver
  8. H) Past medical history and physical examinations
  9. I) Necessary treatment and possible risk factors for the member relevant to the particular treatment
  10. J) All entries are dated
  11. K) A return visit date and follow up plan documented for each encounter
  12. L) The record is legible to someone other than the writer 

The minimum acceptable score on overall performance is 80%. Any practice that fall shorts are required to submit a written explanation and a corrective action plan.

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Insights
October 2018