4049.0: Tuesday, November 14, 2000 - 9:30 AM

Abstract #14122

Presence of Early Periodic Screening Diagnosis and Treatment (EPSDT) indicators in acute care Medicaid claims: Results of a medical record review of Pediatric and Family/General Practice primary care provider visits

William J Miller, PhD1, Robert H. Curry, MD, MPH1, Susan A. McLaren, MPH1, Joe Jordan, PhD2, and Karen Chapman, MDMPH3. (1) Institute of Health Administration, Georgia State University, University Plaza, Atlanta, GA 30303, 404/651-4133, wmiller@gsu.edu, (2) University of South Alabama, (3) Florida Department of Public Health

Background: A study was performed for the Georgia Medicaid program to determine if children were receiving well-child services during acute care visits in place of EPSDT screens, thus, accounting for a portion of the State's low screening and participation ratios. Method: A database of 1997 acute care claims with evidence of EPSDT screening services was created utilizing Georgia Medicaid paid claims. A random sample of 31 providers and 165 recipient medical records was selected. Results: 109 of the requested records were received and reviewed. Each record was assessed to determine whether EPSDT screening elements were present. Records were labeled as containing full evidence, no evidence, or partial evidence for each screening element. Only one record contained full evidence of all EPSDT screening elements, while 50% of the records reviewed indicated that full or partial evidence was present for all screening elements. The liberal analysis, which excluded certain elements from the assessment, found that 67% of the records contained full or partial evidence of EPSDT screening elements. Conclusion: It is clear that while Medicaid providers are treating patients with acute care conditions, they also may be performing services that constitute partial completion of an EPSDT screen. States can benefit from educating providers in the importance of providing EPSDT screens when patients are available, even in the course of an acute care visit. The provision of such EPSDT services should be adequately completed and documented in the chart, so that the provider can bill for the screening services.

Learning Objectives: Learning Objectives: 1. To demonstrate through medical record reviews that evidence of well-child screening elements may be present in other physician services claims; 2. To encourage providers to perform more detailed recording and bill for EPSDT services; and, 3. To illustrate how states may be under-reporting screening ratios

Keywords: Child Health,

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Georgia Department of Community Health, Division of Medical Assistance
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Currently, the Institute of Health Administration is performing an Independent Evaluation for the Georgia Medicaid Program

The 128th Annual Meeting of APHA