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Plan Info

2013 Focused Audit Results

2013 focused audit results

Audit Medical Records

In 2013, Health Partners Plans (HPP) Quality Management conducted three focused audits of medical records and identified these areas where improvement is needed:

Appropriate testing for Children with Pharyngitis

The audit revealed that many providers are performing throat cultures prior to prescribing antibiotics. It was determined that these providers may not be billing appropriately for the culture since the testing was not found during claims review. Providers should collect a Rapid Strep culture prior to prescribing antibiotics and use billing code 87880.

Adult BMI Assessment (ABA)

The audit found that providers are not providing diet/nutritional and/or exercise/physical activity counseling to members whose BMI classifies them as overweight or obese. If they are providing the counseling, they are not documenting it.

It is important to document the BMI, as well as nutrition and exercise recommendations. Patients should be encouraged to take advantage of the HPP Weight Watchers® and fitness center benefits.

Advance Directives

This audit uncovered that providers are not discussing advance directives or life planning with their patients. For your convenience, the provider section of the HPP website includes links that will connect you to resources that can assist with explaining advance directives and life planning.