Medical Record Guidelines > Auditing Primary Care Physician (PCP) Medical Records
The Quality Review Operations department conducts ongoing audits, based on randomly selected charts, of a PCP's medical record documentation procedures. We inform PCPs of their results at the time of the audit.
Those PCPs who do not score at least 90 percent are offered a means of correcting a deficiency immediately after review and are enrolled in one-year of monitoring, during which EmblemHealth will educate and provide practitioners with record-keeping aids. A nurse reviewer will then re-audit by viewing at least three records seen by the PCP during the monitoring period.
Glossary terms found on this page:
Acronym for Medicare Advantage. An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program.
A family physician, family practitioner, general practitioner, internist or pediatrician who is responsible for delivering or coordinating care. Also called a primary care physician.
A family physician, family practitioner, general practitioner, internist or pediatrician who is responsible for delivering or coordinating care. Also called a PCP.