Treatment Record Review Results 2009
Improvement Noted in Treatment Record Documentation
Each year, Magellan audits member treatment records documented and maintained by our high-volume network practitioners. This systematic review measures practitioner compliance with our treatment record standards to evaluate and, if necessary, work to resolve issues that may impede the quality or success of member treatment. In addition to the annual review, we conduct treatment record audits whenever significant quality-of-care issues arise.
The Michigan Care Management Center’s review of 42 provider treatment records between January and December 2009 showed that 71 percent of providers complied with Magellan’s minimum treatment record review standards—reflecting a significant increase from the 2008 results of 58 percent. While Magellan commends this increase, we continue to ask providers with scores below the minimum of 70 percent compliance to submit improvement plans.
Areas of Focus
As part of the treatment record review process, we evaluate eight primary categories:
- general information
- member rights and member confidentiality
- initial evaluation
- coordination of care
- treatment plan
- progress noted in treatment
- medication (applies to psychiatrists)
- referral/outreach.
Results
Magellan congratulates providers for noted 2009 improvements in the areas of general information; progress in treatment; and documentation of some, but not all, aspects of the coordination of care.
For those providers who did not obtain a passing score (70 percent or better) in 2008, subsequent treatment record reviews in 2009 resulted in passing scores for 78 percent of those same providers.
Opportunities for Improvement
While providers have made significant progress, the areas listed below remain out of compliance. Please review and implement the accompanying recommendations into your treatment records.
Member Rights and Member Confidentiality
Issue: No documentation of the use of member rights and consent forms.
Recommendation: Include a treatment consent form, member rights and an authorization to disclose to primary care physician (PCP) form in the paperwork to be completed by the member at his or her initial visit.
Coordination of Care
Issue: No documentation demonstrating coordination of care with members’ PCP.
Recommendation: Obtain authorization to communicate with the PCP and document contacts with him/her in treatment record notes in the member’s clinical record. (Note: If the member refuses authorization to communicate with the PCP, document member refusals in the treatment record and/or on the authorization form, and have the member sign the documentation).
For further information about Magellan treatment record review standards, refer to the Provider Handbook on this website. If you have questions regarding the record review process, please call Jeanne Bachmann, QI Director at 800-503-3159 x 62969.