tbragg36
Networker
I work for a provider who was established in 2020. The only insurance carrier the provider is par with is Medicare. We are receiving a letter from UHC about a Medicare Advantage policy chart review. I sent an email to the provider informing them of the chart request and the below is the providers response.
' Medicare Advantage but that falls under UHC management as what’s implied as a Medicare Advantage Agreement. Medicare has not directly request any medical records from us. This would only be the case if the patient was “Original Medicare.” Once it’s controlled by a Health insurance such as UHC, they now become their own governing body. If Medicare doesn’t raise issues and we are not contacted with them, I do not think we need to follow their request.'
This provider is new and has no idea about "Medical Chart Reviews". I've been looking for literature written by CMS about complying with a chart review/audit. I find things about Medicare but not the Medicare Advantage. Does anybody have anything to share with me. The provider doesn't think refusing medical records sends up red flags and doesn't imply there's fraudulent actions. The provider really feels they have the right to say no. Please help!
' Medicare Advantage but that falls under UHC management as what’s implied as a Medicare Advantage Agreement. Medicare has not directly request any medical records from us. This would only be the case if the patient was “Original Medicare.” Once it’s controlled by a Health insurance such as UHC, they now become their own governing body. If Medicare doesn’t raise issues and we are not contacted with them, I do not think we need to follow their request.'
This provider is new and has no idea about "Medical Chart Reviews". I've been looking for literature written by CMS about complying with a chart review/audit. I find things about Medicare but not the Medicare Advantage. Does anybody have anything to share with me. The provider doesn't think refusing medical records sends up red flags and doesn't imply there's fraudulent actions. The provider really feels they have the right to say no. Please help!
