TRUMBULL, Conn., Nov. 25 /PRNewswire-FirstCall/ -- Oxford Health Plans,
Inc., (NYSE: OHP), 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 (http://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
This press release may contain comments that are considered
forward-looking statements within the meaning of applicable federal securities
laws, which are subject to a number of risks and uncertainties that could
cause actual results to materially differ from those anticipated. A
discussion of those risks and uncertainties is included in the discussion
under the caption "Cautionary Statement Regarding Forward-Looking Statements"
in Part I, Item 1, of the Company's Annual Report on Form 10-K for the fiscal
year ended December 31, 2002 and Part I, Item 2, of the Company's Quarterly
Report on Form 10-Q for the period ended September 30, 2003.
SOURCE Oxford Health Plans, Inc.
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Related links:
http://www.oxfordhealth.com
Company News On-Call:
http://www.prnewswire.com/comp/104612.html
CONTACT:
Maria Gordon Shydlo of Oxford Health Plans,
Inc., +1-203-459-7674, mshydlo@oxfordhealth.com
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