Anthem dictates how we supply phone numbers
Anthem, along with most other large insurers, randomly comes to our office to do chart reviews and grade us on our practice. The letter above was given to my office manager by the reviewer on the day she arrived.
We were informed that we would flunk the review if we didn't change our after-hours answering machine message. We had an emergency number to call for emergencies, but the message didn't say urgent as well as emergent. If we didn't change the message, they would give us an unsatisfactory report.
We had never been informed of this before and the message has basically been the same for the past 12 years.
This same reviewer also gave us an unsatisfactory mark because as she was reviewing the chart on a 77 year old patient, we did not have documented that we discussed her sexual activities and risk prevention for sexually transmitted diseases and pregnancy. When informed that the patient was 77 and had a hysterectomy, she just commented that we were deficient in our documentation.
We did receive an overall high 90's score, but this is an example of a cookbook approach to chart reviews that is another example of what is so frustrating to physicians.
The lack of common sense and independent thought from reviewers and others in the insurance industry continues to be a thorn in our side.
Forecast for FLOYDS KNOBS, IN (on a scale of 1-12):
Today's allergy levels:
Thursday - 5.8/Medium
Today's predominant pollen:
Grass, Mulberry and Hickory/Pecan.
Today's allergy levels:
Thursday - 5.8/Medium
Today's predominant pollen:
Grass, Mulberry and Hickory/Pecan.
posted by Anonymous at 6:00 AM
3 Comments:
This is the same type of foolishness that pervades these review organizations. Now you have Medicare telling nursing homes that side rails on a bed are a form of restraint, therefore patient beds are surrounded by "cushions" if they have a tendency to fall. How ludicrous!!! Medicare, JCAHO, and State Board of Health reviews began as a good thing but as with most governmental agencies they eventually inane rules to justify their existence. Furthermore how can a physician possibly have the time to counsel a pt. on EVERY aspect of their life, if the pt. doesnt consider it a problem. I dont consider my sex life any of my physicians business unless I deem it necessary to initiate a conversation with her/him regarding a problem I might be having. Get the government out of our lives and our business!!!!!!!!!
I'll give that a big AMEN
The inherent conundrum is that it takes an institution like government to control large companies like Anthem. And even then, when put up against many large corporations, government agencies tend to be severely outgunned when they do try to do the right thing.
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