Midwest
Treatment Record Reviews Show Mixed Results
Annually, the Midwest Care Management Center, serving our Employer Solutions customers nationwide, reviews a random sampling of member treatment records from high-volume providers for compliance with Magellan’s treatment record documentation standards. These standards include evidence of communication with primary care physicians and compliance with clinical practice guidelines.
The 2007 Treatment Record Review (TRR) and Clinical Practice Guidelines for Major Depression (CPG) audits showed mixed results. Seventy-nine percent of providers reviewed met the TRR audit threshold, a 3.5 percent improvement compared to 2006 aggregate scores, and 100 percent of providers met the CPG audit threshold. Overall, our providers do a thorough job of meeting our documentation requirements; however we noted some opportunities for improvement.
TRR Results
The TRR audit contains seven sections consisting of administrative and clinical components. Scores from this audit ranged from 58.2 percent to 99.6 percent. The highest scoring sections were in clinical areas, such as documenting the initial evaluation, progress noted, treatment planning and referral/outreach.
The lower scores tended to be in the administrative sections. Treatment records were missing documents such as “bill of rights” forms, proper consent forms and release of information forms to allow communication with primary care physicians. Many records did not document the coordination of care with other providers and member education regarding medications. We encourage you to focus on improving documentation of member education regarding medications prescribed and their potential side effects. Evidence that these activities occurred is important to Magellan as well as to the accrediting and regulatory bodies that review Magellan’s services.
CPG Results
The CPG for Major Depressive Disorder (MDD) audit consists of 25 questions, divided into three separate sections: diagnostic assessment; suicide risk assessment and management; and therapeutic interventions. The 2007 average score reflected overall provider compliance with the documentation requirements in this audit.
The main area of concern we found was the lack of documentation of member education about MDD. We encourage you to take credit for this aspect of the care that you provide by documenting member and family education about MDD in your records. An acceptable alternative to writing about the education you provide in the record might be to include a form that the member can sign indicating that they received education about the diagnosis of MDD.
Please refer to our Provider Handbook and its appendices (particularly appendix A- Audit Tools and appendix E- Magellan Clinical Practice Guidelines) for more information on the treatment record review and clinical practice guidelines that Magellan has established. These references will aid you in keeping a well-documented treatment record. If you have questions regarding the review process, contact the Midwest Care Management Center’s quality improvement manager, Jennifer Sebacher, by e-mail at JLSebacher@MagellanHealth.com.
Thank you for your cooperation with these review processes as we continue our commitment to continuous quality improvement.