Anyone doing EPSDT or HealthStart audits?

renerian, BSN, RN · Oct 14, 2004

Sorry I did not see this post or respond earlier.

renerian

ARBY · Oct 19, 2004

What is EPSDT and, please, tell me about HealthStart audits

THANKS

hoolahan, ASN, RN · Oct 19, 2004

EPSDT is Early Prevention Screening and ?? I forget what else it stands for, I can write in from work one day. It is essentailly a well child visit. It is a program of what the fed and state governments expects to be done for children to prevent illnesses. There are certain things that are supposed to be checked at certain ages/stages. Like CBC and PPD's, and lead screening, etc...

HealthStart is a simliar concept but dictates Maternity care standards. Like what prenatal labs are done, nutrition, psychosicial, and health ed , updates q trimester for some things, etc..

I work for a managed care company, and we go to doc's offices or clinics and review, or audit, the charts of our members to ensure they are getting quality care. We sign a contract with the state to say we will ensure our doc's and clinics/providers follow these guidelines and provide the same standard of care, so we have to do audits to prove it.

I am now doing Medical Record Review audits, basically this is a non-clinical audit, I am simply making sure lab results are signed as read by the doc, consults ordered are in the chart, there is a name or ID on each page of the chart, and if they have hippa and advanced directive info etc... I can tell you right now, only ONE doc of all the ones I did so far have a way to identify if people have an advanced directive, so I am making copies of the state law and handing them out at each site visit, suggesting for now that they make a question on a label and slap it onto their registration forms until they get a chance to re-print them or add it elsewhere.

It is really eye-opening to see how some docs chart and how some don't.

I like this job very much, except this week has been really heavy traveling, and today it rained, so traffic was out of control. It took me twice as long to get where I was going, very aggravating. I had some serious road rage today!

ARBY · Oct 20, 2004

THANKS for the info. It sounds a lot like the HEDIS chart audits I've done the past 3 springs. Thanks again.

marya · Oct 29, 2004

THANKS for the info. It sounds a lot like the HEDIS chart audits I've done the past 3 springs. Thanks again.

What company did you do HEDIS for? I am interested and have been contacted by a MIchigan company as well as an Atlanta company.

Are you doing it again in 2005?

Marya

ARBY · Oct 29, 2004

Hi Mayra,

I did HEDIS for Molina in So. CA the last 2 years. The year before that Q-Mark from CO did it for Molina and I worked for Q-Mark. I'll do them again in 2005 if I can find a company here in West TX. The pay is so good I've even considered going back to CA for 3 months but that's just a little to long to be away from home and living out of a suitcase. :crying2:

Q-Mark inputs their info to laptops that we were each given during the abstraction time. Molina had us put all data on scanner ready papers...both have good and bad points.

GOOD LUCK and let me know what you do.

ARBY