decisionhealth Newsletters, Part B News - 2008 Issue 3 (March)
Ask questions when MA plans ask to see your records
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Article Overview
This article discusses Medicare Advantage record requests and the CMS guidance that governs them. It is aimed at physicians, practices, and billing staff who may receive requests tied to risk adjustment or other plan review activities. The article covers when requests may be appropriate, how contract terms can affect access, what information a request should contain, and when to seek clarification from the plan or CMS Regional Office.
Why This Topic Matters
Medical record requests can affect compliance, workflow, and payment timing. Understanding the general framework helps practices evaluate whether a request is expected, ensure the request is properly documented, and know when to seek additional guidance.
What You Will Learn
- The general CMS framework for Medicare Advantage record requests
- How contract language can affect whether a plan may review records
- What kinds of information should accompany a record request
- When to seek clarification from the plan or CMS Regional Office
- How record review requests can affect practice workflow and payment processing
Who Should Read This
- Physicians
- Medical practice managers
- Billing and coding staff
- Compliance staff
- Health care administrators
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