EmblemHealth’s Quality Management department is required to conduct several medical record audits each year for regulatory reporting and quality assurance purposes. The medical audit field team consists of nurses and non-clinical support. When on site, the team will answer any questions you may have.
If you are contacted to supply medical records for these audits, you are encouraged to respond as expeditiously as possible. Rest assured that in supplying the requested records to EmblemHealth, you are in no way violating any HIPAA privacy rules.
January - December: DOH Communicable Disease Record Audit
The DOH Communicable Disease audit evaluates the compliance of practitioners in following the DOH guidelines for notifying a positive result of a communicable disease.
March - May: HEDIS/QARR Medical Record Review
The HEDIS (Healthcare Effectiveness Data and Information Set)/QARR (Quality Assurance Reporting Requirement) audit involves the following measures:
For additional information and a complete outline of the above measures, please go to www.ncqa.org.
August - September: Quality Medical Record Audit
The Quality Medical Record Audit follows EmblemHealth’s medical record documentation guidelines and may involve disease-specific guidelines and HEDIS measures.
October - December: DOH Article 44 Prenatal Audit
The DOH Article 44 Medical Record Audit evaluates:
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