May/June 2005 - Center Care Health Benefits Programs

Striving for
Quality Excellence
Medical Record Policy
To assist you in delivering the best possible care to your patients, we
have established five important criteria and documentation standards for
all participating practitioners. For your reference, these standards are
highlighted below.
1. CONFIDENTIALITY
Participating practitioners must treat the following information as
confidential in accordance with their Aetna contract and applicable
laws. Information that:
■ Identifies a member
■ Specifies the relationship of the member with Aetna
■ Addresses physical or mental health status or condition
■ Identifies the provisions of health care and payment details
Participating practitioners must maintain administrative, technical and
physical safeguards to protect the privacy of members’ protected health
information (PHI).
2. MAINTENANCE AND AVAILABILITY OF MEDICAL RECORDS
■ Contractually, practitioners agree to maintain medical records in a
current, detailed, organized and comprehensive manner in accordance
with customary medical practice, applicable laws and accreditation
standards. This requirement survives the termination of the contract,
regardless of the cause for termination.
■
Aetna shall have access to medical records, including confidential
information, for the purpose of claims payment, assessing quality
of care, medical evaluations and audits, and utilization management
functions.
3. MEDICAL RECORD DOCUMENTATION STANDARDS
Our medical record documentation standards provide a guideline for
fundamental elements of organization, documentation of diagnostic
procedures and treatment, communication and storage of medical records.
For the most up-to-date and complete guideline, refer to the Health Care
Professional Toolkit on the secure website.
4. ASSESSMENT
Each year, Aetna audits a selected sample of PCP offices to assess
compliance with medical record documentation standards.
5. PERFORMANCE GOALS
In the North Central Region, 100 percent of audited PCP practices will
score 85% or greater on the documentation review.
Our medical record criteria and
documentation standards are
available in the Health Care
Professional Toolkit, on the secure
website. Visit www.aetna.com.
Select “Doctors & Hospitals,”
select “Self-Service” and log in.
Then click on “Doing Business
with Aetna” and select “Health
Care Professional Toolkit.”
10 Aetna OfficeLink Updates