Retrospective Post Payment Claim Review 2019 Q2 Documentation Requirements

OutPatient Review Objective: PEDIATRIC CHIROPRATIC Providers must submit the signed and dated initial evaluation regardless of the dates of service under review. • Documentation to include: Initial Evaluation Description of Presenting Condition/Chief Complaint(s) Evaluation of Musculoskeletal or Nervous System through Physical Exam Method of Diagnosis of Subluxation Treatment Plan

Outpatient review objective: Acupuncture Providers must submit the signed and dated informed consent regardless of the dates of service under review. Without these documents, KEPRO will deny the case. Patient Interview to include Brief History and Limited Physical Exam Diagnosis for the Cause or Origin of Symptom(s) Being Treated Traditional Acupuncture Examination and Diagnosis Record of Treatment, including Points Treated Evaluation and Instructions Given to Patient Progress Notes Referral to Other Providers Treatment Plan

Inpatient review objective: Short Stay APR DRG Review Physician Orders to include Inpatient Admission Order History and Physical Examination Consultation Reports Transferring Facility Report, Progress Notes, Physician Orders Physician, Nurse, Case Management, Social Work, Therapy and Other Progress Notes Surgery, Anesthesia and Other Procedure Records Laboratory Results Diagnostic and Imaging Results Dialysis, Chemotherapy, Radiation, and Transfusion records Transplant Reports Ventilator and Other Flow Sheets Nursing and Other Flow Sheets Medical Equipment Records Medication Administration Records (MAR) Patient Education Records and Flow Sheets Emergency Department Records Discharge Summary, Discharge Orders and Discharge Instructions Providers must submit the signed admission order. Without this document, KEPRO will deny the case.

Inpatient review objective: Observation Prior to Admission Physician Orders to include Inpatient Hospital Admission Order Consultation Reports Transferring Facility - Transfer Reports, Progress Notes, Physician Orders History and Physical Examination Physician, Nurse, Case Management, Social Work, Therapies, and Other Progress Notes Surgery, Anesthesia and Other Procedure Records Laboratory Results Diagnostic and Imaging Reports Dialysis, Chemotherapy, Radiation and Transfusion Records Nursing and Other Flow Sheets Medical Equipment Records Medication Administration and Dispensing Records (MAR) Patient Education Records and Flow Sheets Emergency Department Records Discharge Summary, Discharge Orders and Discharge Instructions Providers must submit the signed admission order. Without this document, KEPRO will deny the case.

Additional documentation requests During the review process, the Nurse Reviewer may need additional documents. A message will be entered into the Atrezzo Portal A Letter will be sent via fax listing the additional documents needed to complete the review. A MN Retro Review message will also be sent via the Atrezzo portal listing the additional documents needed to complete the review and will be visible the next time the provider logs into the system. When the documents have been pulled, please upload them to the Case ID number listed on the letter.

Review Completion Once the Nurse Reviewer completes the review a message will be put into the Atrezzo Portal as follows: “The Minnesota Department of Human Services (DHS) will review the results of the reviews.  DHS will contact the provider only if follow up is indicated.  No action is required at this time.”  

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