Providers Quality Improvement Activities

Empower Quality Department Announces Launch of Empower Medical Record Documentation Audits

Empower Healthcare Solutions is in the process of launching its first Provider Medical Record Documentation Audits.  These Medical Record Documentation (MRD) Audits will be conducted with Primary Care Physicians (PCPs) and Behavioral Health Physicians in the Empower network.  

These audits are an integral part of Empower’s Quality Improvement process, which seeks to improve member care and treatment outcomes.  The audits are conducted with the intent of improving the quality of providers’ medical recordkeeping and assuring that providers comply with state and federal regulations and other established standards, such as the Empower Provider Manual.  [Note: These MRD audits will not review for the medical necessity of services provided.]

Checklists for Medical Record Documentation Audits

An audit checklist that will be utilized for review of the documentation in the member records has been developed for the PCP records and a different checklist for the Behavioral Health Physician records. 

The Checklists were developed utilizing standards identified in:

  • Manual for Empower Healthcare Solutions Providers;
  • Arkansas DHS Manuals;
  • Federal and state requirements (such as HIPAA and CMS standards; Arkansas Child and Adult Maltreatment Acts);
  • NCQA standards, best clinical practices, and Empower Clinical Practice Guidelines; and
  • National Accreditation standards.

All documentation in the member’s medical record for which the identified physician has medical responsibility may be reviewed as part of the audit.  For example, if the selected Behavioral Health Physician provides services in an outpatient behavioral health program and is, therefore, medically responsible for all of the member’s behavioral healthcare, documentation of all services provided to the member are subject to review (not just the physician’s).

To see the Medical Record Documentation Audit – Behavioral Health Physicians Checklist click here.

To see the Medical Record Documentation Audit – Primary Care Physician Checklist click here.

Revised Medical Record Documentation Audit Timeline

In mid-December, providers who have been selected via a random sampling will receive a Notification Letter telling them that they have been selected to participate in the MRD Audit.  The letter will include

  • a copy of the applicable MRD Audit Checklist (based upon provider type) that will be utilized
  • an explanation of the MRD Audit process
  • information regarding record submission. 

In the week following the mailing of the Notification Letters, Empower will reach out to those providers in order to obtain the contact information for the staff persons who will be responsible for providing requested records to Empower and the method that the provider plans to use to submit records.  

At the beginning of January 2021, providers will receive a list of five (5) members whose records will be audited and a list of the requested documentation.  Requested records must be submitted to Empower within fourteen (14) calendar days.

Providers may submit or give access to records utilizing several methods:

  • secure email
  • direct access to the provider’s electronic medical records for the identified members
  • fax
  • Secure File Transfer Protocol option, which will allow providers to upload records to a secure server (not yet available, but expected to be available by December).

When the audits are completed, feedback will be given to each provider whose records have been reviewed.  Results from individual provider audits will not be published.  Empower will aggregate the results of all record audits and review the data analysis of findings to identify key processes for quality improvement.

To see the Timeframes for Medical Record Documentation Audits click here.

Watch the Empower website for updates on the Medical Record Documentation Audits! 

COVID-19 and Other Communicable Diseases: Potential Quality of Care Review of Empower Provider Policies and Practices

The Quality Management Department is launching a Potential Quality of Care (QOC) review of Empower providers’ policies and practices relative to COVID-19 and other communicable diseases.  This review is a part of Empower’s Quality Improvement process, which seeks to improve member care and treatment outcomes.  Empower Staff and Providers have the responsibility to ensure the health and safety of individuals who are enrolled in the Arkansas Medicaid PASSE program and review concerns that place the health and safety of members at risk.

Because of the COVID-19 pandemic, Empower understands that our members are at risk of contracting the disease, as we have seen increasing numbers of our members with diagnoses of COVID-19.  As with any communicable disease, our members are placed at risk by many factors, some of which include residing in group homes and facilities and staff coming and going from members’ homes and facilities in which they are receiving services. 

With this heightened awareness and risk, Empower wants to insure that providers have:

  • Policies, procedures, protocols, and mitigation plans to prevent the spread of COVID-19 (and other communicable diseases) when there is a positive identification of provider staff or members 
  • Policies, procedures, and plans to insure the continuation of treatment services for members when face-to-face contact is not recommended.

For the initial phase of this potential QOC review, Empower is sending letters requesting related policies, procedures, and plans to Psychiatric Residential Treatment Facilities and Intermediate Care Facilities.  The letters will provide the details of the information that providers are asked to submit to Empower.

Empower appreciates the work and efforts made by our providers to ensure the health and safety of our members and your staff! Thank you!