Print

MMAI, ICP and FHP Ambulatory Medical Record Review Begins February

Posted February 6, 2017

Blue Cross and Blue Shield of Illinois (BCBSIL) conducts an annual Ambulatory Medical Record Review (AMRR) audit for all BCBSIL independently contracted providers. Each BCBSIL provider is required to maintain an ambulatory, or primary medical record, for each member that contains sufficient medical information from all providers involved in the member’s care to ensure:

  1. Compliance with medical record documentation requirements, practice guidelines and minimum standards of care.
  2. Patient safety by focusing on continuity and coordination of care.
  3. Documentation of the clinical care delivered.

Providers participating in the Blue Cross Community MMAI (Medicare-Medicaid Plan)SM, Blue Cross Community Integrated Care Plan (ICP)SM and Blue Cross Community Family Health PlanSM (FHP) contracts will undergo medical record reviews beginning in February 2017. 

As part of the medical records review, in 2017 BCBSIL will conduct an Adult, Pediatric and Obstetric (OB) AMRR on a random sample of MMAI, ICP and FHP medical records with dates of service from calendar year 2016 to obtain baseline information. Based on the results, if the score in a certain section of the review is less than 80 percent, BCBSIL will suggest ways to improve that section in a future Blue Review issue. 

Beginning in 2018, BCBSIL will conduct an Adult and Pediatric AMRR on a random sample of MMAI, ICP and FHP Primary Care Providers (PCPs) to assess PCP compliance and documentation of high quality health care according to established standards. The review will include PCP, ambulatory care and Early and Periodic Screening, Diagnostic, and Treatment (EPSDT). OB AMRR will continue to be completed on a random sample of MMAI, ICP and FHP medical records. 

Providers participating in MMAI, ICP and FHP must achieve a minimum total overall score of 80 percent on the AMRR in 2018. Providers who score 80 percent or better on the review will not be audited for another two years. Providers scoring less than 80 percent on the review will receive written communication and a suggested action improvement plan from BCBSIL and will be re-audited during the next annual AMRR. 

BCBSIL will report trends and outcomes of the AMRR to the Service Quality Committee annually and as needed. 

If you would like more information about the AMRR, please call Renee Foster-McFarland, RN, MSN at 312-653-8938 or send an email to Renee_Foster-Mcfarland@bcbsil.com.