Empower conducts an annual provider Medical Record Documentation Review (MRDR) as part of an ongoing commitment to promote continuous evaluation and improvement in quality of care, safety, and treatment outcomes for our members. In keeping with the guidelines outlined in the Arkansas PASSE Agreement, the MRDR is one of the quality improvement initiatives that the state mandates. Its purpose is to identify patient documentation practices that need improvement, so, they remain compliant with state and federal regulations and other quality standards. This is not a review of claims and billing practices, for the determination of medical necessity, or fraud, waste, and abuse of services rendered. However, if evidence of suspected fraud, waste and abuse is uncovered during the standard review of members’ medical records, Empower is obligated to thoroughly investigate the evidence further and report the findings to the appropriate authorities, including the Office of Medicaid Inspector General.

As announced in the June 2022 Provider Newsletter, Empower is set to launch the 2022 MRDR.

According to the “General Principles of Medical Record Documentation” by the Centers for Medicare and Medicaid Services (CMS), “the medical record chronologically documents the patient’s care and is an important element contributing to high-quality care.” CMS requires that every provider and practitioner of care creates and maintains electronic or paper medical records for every patient they render services to. Furthermore, all PASSE Providers are required to cooperate with all quality improvement initiatives by Empower. Medical records should be current, detailed, complete, accurate, legible, and organized to comply with federal and state regulations and standards. There are documentation requirements for different provider types (i.e., medical service providers, behavioral health providers, home and community-based service providers, and psychiatric residential treatment facilities). These guidelines are available for review by all providers in the applicable Arkansas Department of Human Services Medicaid Provider Manuals.

Empower members represent a unique niche in the healthcare services they utilize the most. These services can range from acute illness, injury, or exacerbation of a chronic condition to long-term residential care and disease management. The providers included for the 2022 MRDR gave the most comprehensive representation of the services utilized by the most members. The 2022 MRDR represents two provider groups and five subgroups. Behavioral Health Providers (i.e., psychiatrists only) and Primary Care Physicians have been and continue to be included, but the review has been expanded to include psychiatrists, licensed social workers, psychologists, pediatricians, and family medicine physicians.

Random selection methods are used to select from these provider types and records requests will be limited to members that have had at least three visits within the last year. Records should be submitted to Empower via encrypted/secure email or fax. Once all the records have been received, a systematic review of each medical record will be conducted utilizing a standard record review checklist.

Empower is using two different criteria checklists in the 2022 MRDR, the Behavioral Health Providers Checklist and the Primary Care Physicians Checklist. Each was developed from multiple sources using the criteria from state and federal regulatory standards as evidence-based guidelines for clinical practice. The PCP checklist includes additional clinical assessment components for both pediatric and adult members, and those needing obstetrical care.

2022 MRDR – Behavioral Health Providers Checklist

2022 MRDR – Primary Care Physicians Checklist

Once the review of records is complete a letter and a copy of the review scorecard will be sent to the participant.  The letter will include recommendations for improvement, if applicable in specific areas that were identified during the review of the documentation submitted. No individual provider's results will be made public. However, providers that are found to have major deficits compared to the standards will need to submit a corrective action plan.

The complete MRDR Process is further detailed in the online 2022 MRDR Provider Training.