Welcome back to our last installment of this three-part series on specialty providers and risk adjusted payments. Part 2 of this blog series focused on the substance of consultation notes, while today, we evaluate our topic from the perspective of staff members who conduct chart reviews.
Historically, an important task of the MRA staff member is to identify risk adjusted conditions. Staffers do this by combing through the patient’s chart and identifying conditions that have not been recognized by the PCP in previous visits. These new diagnoses may be found in laboratory or imaging studies, hospital records and specialist notes. The big caveat is that MRA staff must be “plugged in” and not just mindlessly suggest conditions because they happen to appear on a document.
With regard to specialists’ notes, as we introduced in Part 2 of this series, we must be mindful of who is reporting a condition, so let’s return to our beleaguered rheumatologist who’s behind on her work because we keep bothering her in this blog series LOL Let’s assume that during a discussion of past medical history, the patient mentions to the rheum that he has had seizures but is not on any seizure medication, and the rheum lists seizure disorder on the assessment.
The MRA staffer reviews the chart, sees the rheum note and suggests seizure disorder to the PCP as a diagnosis to include in the chart “because the rheumatologist documented it.” Don’t be too quick to deem this an exaggerated scenario that couldn’t happen in real-life. We’ve seen this situation more times than we can count in our chart audits, second only to a greater cause of MRA confusion: the specialist who uses a differential diagnosis to order a test. It’s important for the MRA employee to critically evaluate the documentation about a condition before querying the PCP or suggesting the diagnosis for evaluation. In our seizure disorder example, there will likely be nothing concrete in the rheum’s note to support this medical condition, and the diagnosis should not be suggested to the PCP. Instead, the MRA staff should carefully review the chart for any evidence supporting a possible seizure disorder.
MRA chart reviewing and coding are meticulous work and great attention must be paid to the conditions “found” in the chart. Context is everything in this type of work and medical groups should develop standards of practice for the identification of new risk adjusted conditions for reporting.