1. Retrospective Post Payment Claim Review 2019 Q2
Documentation Requirements

2. 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

3. 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

4. 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.

5. 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.

6. 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.

7. 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.”

8. Question & Answers
Thank You for Joining this Review Objective Overview