|Posted by slewis on June 14, 2017 at 3:40 PM||comments (0)|
Many of you know that HEDIS requests records every year but you might not realize why. They use certain measures to grade the care provided to patients. Insurance companies look at our collective report card and either reward us by paying more on our claims or punish us by paying less. This is why some medical providers push immunization schedules! HEDIS doesn't actually give us a better score when we push vaccines; but the refusal needs to be documented in the chart. That shows them the "care" was offered by the practitioner.
Midwives honestly provide A+ care that goes over and above standardized care expected of healthcare professionals; however, some midwives don't realize making a few basic improvements in charting can make all the difference! Payer don't care what a woman ate during labor, who attended the birth or what comfort measures were used. They are looking for very defined care markers documented in the chart.
Example: A single postpartum exam was performed between day 21-56 and one of the following three components was present:
- Pelvic exam
- Weight, BP, Abdomen and Breasts evaluated (notation of breastfeeding is sufficient)
- PP Check, PP care noted on chart or completion of a pre-printed postpartum care form
Midwives don't get extra credit for doing three postpartum visits and they don't get ANY credit if one of the above mentioned items is not documented.
*Download HEDIS checklist for Pregnancy Care Providers in Members Only section
|Posted by slewis on June 14, 2017 at 3:35 PM||comments (0)|
Health care requires high attention to detail, efficiency, accuracy, and effectiveness. That's why back-office staff must be trained thoroughly and regularly on principles, policies, procedures and techniques.
Your account manager functions as your "back office" for claims you send through us. She gets paid to negotiate with insurance payers and answer questions concerning your claims. Don't spend your valuable time looking for information or trying to negotiate with stingy payers! If you answer a call from Multiplan or a payer, tell them to call your back office and give them your account manager's name and fax number. Those numbers are available on your manager's page on our website.
If Multiplan or a payer leaves a message for you to return their calls, forward to your manager and she will return the call. Its that easy!