Heart Failure Management FINAL2 Audit Form 2008

Blue Cross and Blue Shield of Minnesota R e cog nizing Excellence 2008 Heart Failure Management Audit Form Pay-for-performance program Last Updated: 10/7/08 Blue Cross and Blue Shield of Minnesota is a licensee of the Blue Cross and Blue Shield Association 2008 Recognizing Excellence (RE) Medical Record Audit Form Numerator Tally Heart Failure Management Meets RE criteria? 1Yes 1No Date of Review: ____/____/___ Reviewer: ____________________ Clinic Sample ID#: _________ Clinic System:____ ____________ Specialty: Cardiology Clinic site: __________________ BCBS Member ? 1Yes 1No Clinician ID (optional): _____________ Instructions: Review only the charts that meet the verified inclusion criteria referenced in the criteria summary table (patient’s age 18 and older, diagnosis of heart failure prior to Dec. 31, 2008, dates of service going back 1 year from Dec. 31, 2008). Answer each question with either yes or no. Missing information is considered a NO. Retain this audit tool with your Recognizing Excellence records for reference. Verify Inclusion Criteria: 1. Is the patient age 18 or older as of Dec. 31, 2008? (Date of birth on or before Dec. 31, 1990) 1 Yes 1 No If the answer is yes, proceed with next question. If no, do not include this record in the denominator. Pull a new medical record from eligible ...