College of Optometry Header

 

4/02/2002; 03/17/2004; 10/08/2006

 

Standard Operating Procedures

Front Desk Medical Record Review

Center for Eye Care

 

Medical record standards for specialists 

 

I. Review superbill for completeness and accuracy

    1. patient demographics

    2. 3 required signatures with verification

      a. patient

      b. attending optometrist

      c. student

    3. ICD-9 codes

    4. CPT codes

    5. insurance information

    6. next appointment time

    7. financial information

      a. charges

      b. adjustments

      c. payments

II. Review Compulink Practice Management database for completeness and accuracy of financial transactions

    1. charges

    2. adjustments

    3. payments

    4. attending optometrists performing service

    5. financially responsible party

III. On the Compulink financial screen indicate

    1. insurance authorization numbers

    2. attending optometrist for Medicare

V. Enter in Compulink Practice Management database

    1. correct insurance policy number

    2. date of release (original date of service)

    3. clear inactive insurance carriers

VI. Make necessary corrections

    1. notify attending optometrists and students of the need for corrections before checkout

    2. notify Center Manager of continued need for repeated corrections


MEDICAL RECORD STANDARDS for SPECIALISTS (NCQA)

Appropriate health education is documented on all patients

Care is rendered in a timely and appropriate manner

All pages contain patient identification

There is biographical/personal data

There is only one patient's medical record in a chart

All progress notes are signed or initiated by writer

Every entry is dated

The record is legible to someone other than the writer

Errors are appropriately marked through and Initialed (i.e. no white out or black out used)

All pages are secured

Allergies and adverse reactions or the notation NKA is clearly documented

Past medical history is documented

Past history relating to condition is documented

Physical findings are recorded at every encounter

Diagnosis is recorded at every encounter

Presenting problem or symptoms are documented

Documentation of smoking, if relevant to condition

Documentation of alcohol use. if relevant to condition

Documentation of illicit drug use. if relevant to condition

Instructions regarding dose, frequency and length to take are documented when medication is prescribed

Medication given In the office is identified by name, site route given & dose

The plan of treatment is documented

Follow up plan is documented

Problems from previous visits are addressed

There is evidence of continuity and coordination of care between specialist and primary care physician

If diagnostic tests are ordered, the results are documented

The physician has noted the results of the diagnostic tests

The physician has documented what was done regarding abnormal results

The patient received notification of abnormal test results

Signed informed consents are in chart when procedure requires IV sedation or other forms of anesthesia except local anesthesia

The office has a confidentiality policy

If the physician has more than one office there is a procedure to ensure the medical record is available whenever the member is seen