26.11.03

26.11.2003: Meldung: Oxford Health Plans, Inc.: Industry Documentation Standards

Oxford Health Plans Joins With Major Behavioral Health Provider Organizations To Improve Industry Documentation Standards
Tuesday November 25, 5:31 pm ET

TRUMBULL, Conn., Nov. 25 -- Oxford Health Plans, Inc., (NYSE: OHP - News), a leading regional health plan in the tri-state area, announced today that it has joined with the American Psychiatric Association, the New York State Psychiatric Association and the New York State Society of Clinical Social Work to develop and adopt mutually acceptable standards for office clinical record documentation for behavioral health providers.

In 2002, Oxford Health Plans initiated a review of behavioral health services claims as part of its fiduciary responsibility to members and employer groups to prevent and eliminate fraud. After an audit of behavioral health claims, Oxford discovered that there was more variability in clinical documentation among behavioral health providers than in other clinical specialties. As a result, Oxford identified a small number of behavioral health providers from whom it requested financial recoveries for several issues including note taking.
Although this is potentially a quality issue, Oxford came to recognize that in many cases the variable clinical record documentation among behavioral health providers was not a result of fraud. While professional standards and guidelines state that appropriate documentation is important, the inconsistency of interpretation of these guidelines in day-to-day behavioral health clinical practice have contributed to a disparity in standards of behavioral health documentation.
Rather than continue to pursue repayment of claims, Oxford determined that partnership with major behavioral health organizations to develop and adopt clear, consistent standards for all behavioral health providers -- including psychiatrists, psychologists and social workers -- was in the best interest of the company, its providers and its members.
As a result of this decision, Oxford will terminate current audits of behavioral health providers that are related to documentation. It also will refund any sums received from providers in the few cases where audits were previously settled and will return all copies of patient records. However, the company will continue to pursue those few providers who have engaged in fraudulent billing, unlicensed care or other issues unrelated to documentation.
"Variability of documentation has the potential to impact the quality of patient care," said Alan Muney, M.D., chief medical officer of Oxford Health Plans. "We are pleased to be working collaboratively with the leaders in behavioral health to resolve any disparities regarding what constitutes adequate clinical record documentation."
"We are pleased that Oxford has responded to our concerns regarding documentation audits by taking steps to bring these audits, and the demands for repayment, to an end. We welcome the opportunity to work with Oxford to establish the standards that will ensure acceptance by third-party payors while respecting the sensitive nature of psychiatric treatment," said Seth Stein, executive director of New York State Psychiatric Association.
"Since beginning this audit, we were pleased with Oxford"s sensitivity to patient privacy concerns, as well as the spirit of collaboration as we worked together to address the important issue of documentation," said Hillel Bodek, chairperson of the Committee on Ethics and Professional Standards and incoming president of the New York State Society for Clinical Social Work. "We support Oxford"s initiative to create clear and consistent documentation standards for the behavioral health specialties and appreciate the emphasis on education rather than retroactive penalties."
Founded in 1984, Oxford Health Plans (www.oxfordhealth.com) provides health plans to employers in New York, New Jersey, and Connecticut, through its direct sales force and through independent insurance agents and brokers. Oxford"s services include traditional health maintenance organizations, point-of-service plans, third-party administration of employer-funded benefit plans and Medicare+Choice plans.
Oxford Health Plans, Inc. - Cautionary Statement Regarding Forward-Looking Statements

Source: Oxford Health Plans, Inc.
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