|
Utilization Review
Why is Quality Documentation Important?
According to the ACA …
1. National insurers note the single most important element in clinical documentation, which can avoid up to 50% of unnecessary requests for information and reduce claim delays, is the accurate correlation of documentation to support the ICD-9-CM diagnostic codes reported and all CPT and HCPCS codes billed.
2. It is clear that clinical documentation is the standard for insurance reimbursement approval and is the basis for determining clinical necessity, and a growing number of insurers and managed care organizations no longer accept billed charges as primary evidence of appropriate patient treatment.
3. Accurate and consistent clinical documentation is an important part of everyday practice.
4. Consistent and accurate documentation is crucial for patient protection, case management, risk management and proper reimbursement.
5. It is the responsibility of the Doctor to meet the needs and expectations of patients and payers in regard to the documentation of patient care in today’s healthcare environment.
6. Doctors of Chiropractic MUST RISE TO A NEW LEVEL OF AWARENESS AND RESPONSIVENESS TO INTEGRATE ACCURATE AND CONSISTENT CLINICAL DOCUMENTATION AS A CORE BUSINESS PRACTICE.
Quote From Dr. Cory J. Hoyer - Estherville, IA
I'm sure you don't get this very often but I want to thank you for raising the bar on soap note taking. As requests for records increase and PI cases become harder it is more important than ever to have good documentation. From what I have seen in other areas in the country we take darn good notes and if it were not for CASD I wouldn't have a clue. I just thought I would send you a quick thank you and I hope you all know there that you are making positive change in the profession.
Why is Utilization Review necessary?
In order to maximize the amount of care that our member doctors are allowed and to keep the reimbursement at the highest level possible, the utilization review department wants to make sure that the care being provided is properly documented and justified and meets the treatment standards and guidelines.
|
