MMP Medical Record Review Update
Periodically, Meridian conducts a medical record review to ensure contracted practitioners maintain medical records in a current, detailed, and organized manner. Taking provider type utilization into account, a review of sample records from multiple health systems and provider offices was completed in October. Each record was carefully reviewed and scored using the criteria below:
| Criteria Number | Criteria Definition |
|---|---|
| 1 | Provider has documented results of X-rays, laboratory tests, and/or examinations performed. |
| 2 | Provider has documented Inpatient, ambulatory, ancillary, and/or emergency care performed. |
| 3 | Provider has documented all other providers participating in member's care |
| 4 | Provider has documented review of services furnished by other providers. (consultation reports) |
| 5 | Provider has documented member's significant illness. |
| 6 | Provider has documented member's history of current medical conditions noted, including date. |
| 7 | Provider has documented presenting complaints and initial diagnostic impression of member. |
| 8 | Provider has documented member's psychological conditions. |
| 9 | Provider has documented member's physical examination findings |
| 10 | Provider has documented current treatment plan. |
| 11 | Provider has documented a current and PRN medication list and is updated as necessary, indicating dose and date of start, stop, and/or renewed |
| 12 | Provider has documented member's allergies and adverse reactions (or a notation that the member has no known allergies [NKA or NKDA] or no known history of adverse reactions) |
| 13 | Provider has documented Evidence that an Advance Directive has been offered to member. |
| 14 | Provider has documented past medical history. |
| 15 | Provider has documented risk factors and applicable preventative services for the member relevant to the member's particular treatment. |
| 16 | Provider has documentation signed and dated by the medical professional rendering the services. (handwritten signature, unique electronic identifier or initials) |
While we saw needs for improvement in documenting the evidence of a member’s Advance Directive and listing other providers involved in the member’s care, the audit showed vast improvement in detail and comprehensive documentation across the board. Normally, for any health systems/providers scoring below 80%, a letter would be sent outlining the areas where improvement in medical record documentation is needed. This year, all of the health systems/provider offices passed the audit, scoring well over the 80% threshold.