Insight into how insurers’ grades help your score
The way insurers score facilities on patient record quality varies from plan to plan. However, there are absolute essentials such as coding accuracy and the presence in the chart of physician signatures.
Yet, there’s also a certain subjectivity to each review, says consultant Susan Keane Baker, MHA, principal at Malpractice Prevention Seminars, a New Canaan, CT, medical documentation firm.
Most managed care organizations (MCOs) offer specific recommendations on where they believe improvement is needed based on individual evaluation. Some use a shopping list of criteria such as neatness and completeness of the charting, which they score numerically and, to some extent, subjectively, Baker notes. They’ll also provide similar numbers from competing facilities for comparison.
At the conclusion, the MCO usually conducts a summation meeting involving the facility’s staff to outline its findings and suggest improvements. Summation meetings are extremely valuable as a learning vehicle, says Melissa H. Jarriel, RRA, director of medical records at the Medical College of Georgia Hospital and Clinics in Augusta.
The difficult part often is ensuring that the hospital and its clinics follow up on the recommendations, Jarriel says.
[Editor’s note: In future issues, Outpatient Reimbursement Management will focus on strategies for implementing change in outpatient health information management.]
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