Adequate and proper medical documentation is essential for quality medical care. We conduct audits to review practitioner documentation and ensure compliance with Centers for Medicare and Medicaid Services (CMS) and New York State Department of Health (NYSDOH) regulatory requirements and to meet National Committee for Quality Assurance (NCQA) standards of patient care.
Here are some of the audits you can expect in 2012:
HEDIS
Our Quality Management Department will soon begin its annual Healthcare Effectiveness Data and Information Set (HEDIS®) audit. HEDIS results are an integral part of the NCQA accreditation process. HEDIS measures allow consumers to readily compare the performance of health care plans.
Prenatal Care Assistance Program Audit
NYSDOH requires all Medicaid Managed Care plans to provide all pregnant members with comprehensive prenatal care services through their participating practitioners.
Primary Care Physician Audit
The Primary Care Physician audit will occur in September 2012.
Communicable Disease Reporting
Practitioners are mandated by both New York State and City health law to report suspected or confirmed cases of communicable diseases to the patient's local health department. Practitioners in New York City may submit reports to the New York City Department of Health and Mental Hygiene.
All diseases that require submission must be reported within 24 hours of diagnosis.
To ensure practitioner compliance with these regulations, we conduct a monthly Communicable Disease Audit. Practitioners are chosen randomly by analysis of
CMS Medical Record Documentation Requirements
The Centers for Medicare & Medicaid Services (CMS) requires that patient medical records are accurate and complete. Complete medical records must be legible and include the patient name and date of service, information supporting the diagnosis, documentation of the treatment plan, outcomes, etc. An acceptable practitioner signature and credentials must accompany each patient encounter in the medical record.
source: EmblemHealth eCommunications February 17 2012
Upcoming Medical Record Audits for 2012
5/6/2012
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