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07/05/2018
RESPONSES/COMMENTS (MEDICAL - LEGAL)
From: Anne Moraca-Sawicki, RN, MSN
Regarding the chart review requests from Medicare HMOs, there is an important clarification which must be made. These reviews have nothing to do with reviewing the doctor's care provided or their documentation. That type of review is covered by your contract and happens at their request, on no set timetable. They may or may not ever happen. The doctor must provide such records at no cost to the carrier (usually stated in contract).
Medicare HMOs are required to not "cherry pick" patients and must provide care to patients requesting coverage. There is a minimum "Acuity Profile" for Medicare patients and payment by Medicare to the HMO is based on patients meeting...
Editor's note: Anne Moraca-Sawicki's extended-length letter can be read here.
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