The Practitioner Conection
Volume XXX, 2nd Quarter

2008 TREATMENT RECORD REVIEWS

Treatment Records
CIGNA's policy sets forth the expectation that treatment records will be established for individuals receiving mental health or substance abuse services with contracted network professionals. Each person's record of care should be confidentially maintained, current, detailed, organized, and allow for quality review. Well-documented treatment records facilitate communication, coordination and continuity of care, and promote treatment efficiency and effectiveness.

The Review Process
CIGNA monitors the treatment record-keeping practices of selected high-volume psychiatrists and therapists to ensure compliance with record-keeping standards. Eighty percent compliance has been established as a goal for each item, and overall on the standardized 32 question Treatment Record Review Tool. The tool is available free, for download and review, in Appendix D of the Medical Management Program Guide. Staff reviewers undergo inter-reviewer reliability training in the use of the tool. Five clinical records and two Employee Assistance Program (EAP) records (if applicable) are audited from each selected professional. Selection of high volume treatment professionals for record review is based on a monthly report identifying those professionals due for re-credentialing in six months, and on the number of participants each practitioner treated in the prior 12 months. The selected professional will receive a written request to send blinded records for the purpose of the audit. A high volume professional is defined as:
• Any physician who has seen 90 or more individuals in the previous 12 months.
• Any Ph.D. psychologist who has seen 35 or more individuals in the previous 12 months.
• Any master’s level therapist who has seen 30 or more individuals in the previous 12 months.

2008 Findings
98% of all reviewed behavioral health professionals, and 90.9% of all EAP affiliates, achieved an overall compliance score of 80% or greater in 2008. Psychologists' scores were lowest for both the behavioral and EAP records, compared with other professions. Nationally, the following four items failed to meet the 80% documentation goal:
• Question #22. Coordination of behavioral care with the PCP scored 65.1%.
• Question #27. Child/Adolescent: complete developmental history scored 70.4%.
• Question #23. Coordinated care with other behavioral clinicians scored 72.4%.
• Question #20. Preventive services, as appropriate scored 79.7%.

If a professional does not meet compliance requirements, they are notified in writing and asked to provide evidence that the problem has been corrected within 90 days of the original review. A second record review is performed for resolution of issues and the professional may be subject to a site visit. Failure to score 80 percent on the second record review may result in additional corrective action, up to and including suspension or termination from the network. If you would like further information on record-keeping standards, contact your Professional Relations or a Customer Service representative.

Other Featured Articles:

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MEDICATION NON-ADHERENCE IN SCHIZOPHRENIA

NEW MIXED SERVICES PROTOCOL

ENSURING ZIP CODE ACCURACY

2008 KEY FINDINGS OF THE QUALITY AND UTILIZATION MANAGEMENT PROGRAM

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