Provider Procedural Manual - The Health Plan

PROVIDER PROCEDURAL MANUAL 2014*Start* Medical Record FocusThe Health Plan Quality Management ProgramQuality of care is enhanced when a member’s medical record is organized and complete.To assist our Providers in this area, the Standards for Patient Records Guideline has beenadopted and distributed. Click here to see the Medical Record Audit Tool SheetAreas that have been targeted for improvement in 2009 – 2014: Click here to see updated forms in the QI Forms and Informational Material Section.Click below to see the following documents: Signature Validation (Signature Log) Preventive Health Focus (Preventive Health Flow Sheet) Problem and Medication Tracking (Problem and Medication Lists) Advance Directive Patient Education Sheet Advance Directive Flow ChartAdvance DirectivesHealth plans, hospitals, and other institutional healthcare providers face a number ofresponsibilities under the Patient Self-Determination Act of 1990. This federal law requires allinstitutional providers delivering Medicare or Medicaid services to comply with severalrequirements related to advance directives.• Primary Care Physicians are required to ask each Health Plan member, 18 years of age andolder, if he/she has an advance directive.• The physician must document the member’s response in the medical record.Under federal law, Medicare Advantage plans must maintain written policies regarding advancedirectives. Medicare Advantage plans cannot discriminate against any person based on whetheror not the individual has an advance directive. Physicians whose moral or religious beliefsprevent them from full support of a patient’s advance directive may transfer the patient to afacility or provider who will support the directive.Section 8 / Page 15