California
Providers Score High on Treatment Record Reviews
We are pleased to report that our 2007 treatment record review results show high compliance among both high-volume and lower-volume providers.
Each year, Magellan’s California Care Management Center* views a random sample of member treatment records for compliance with Magellan’s treatment record documentation standards, including evidence of primary care physician (PCP) communication and compliance with clinical practice guidelines.
Again this year, we are pleased to report that compliance with the two Magellan clinical practice guidelines audited -- Clinical Practice Guideline for Major Depression, and the Clinical Practice Guideline for Assessing and Managing the Suicidal Patient – was very high, with overall scores between 91 percent and 100 percent!
“Providers can be proud that their excellent care for these two conditions is reflected in these results and Magellan is equally proud to have such high-quality providers in its network,” noted Pat Waldhanz, quality improvement director for the California Care Management Center.
Quality of treatment record documentation scores ranged from 72 percent to 100 percent, a significant improvement over last year. An area that fell slightly below standard was documentation that members are aware of their rights, including confidentiality. Regulatory bodies are particularly sensitive to this area and we encourage you to be sure to document that members have been informed of their rights, including confidentiality.
Evidence of coordination of care with the member’s PCP, once permission was given, ranged widely from 89 percent in one group of providers down to 36 percent in a second group of providers. Member refusal rates were low, 3 percent in one group and 39 percent in a second group. Members have become increasingly comfortable with PCP communication over the past several years. We encourage you to respect member permission and follow through with PCP communication when permission is given. Sample authorization and communication forms can be found on the “Clinical Forms” page of this website.
Please consult our Provider Handbook and its appendices for more information on these topics. Appendix A contains our treatment record review documentation worksheet, which lists the items needed in a well-documented treatment record.
*Two Magellan subsidiaries, Magellan Health Services of California, Inc. -- Employer Services and Human Affairs International of California, Inc., operate out of the California Care Management Center.