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UNIVERSITY OF MICHIGAN HEALTH-SPARROW LANSING
FORM AND RETENTION OF RECORDS
Tag No.: A0438
Based on interview and document review, the facility failed to maintain an accurate medical record for one (P-1) of ten patients sampled, resulting in the potential for poor outcomes. Findings include:
Document review revealed P-1 was a 50-year-old female who presented to the facility on 04/04/2022 for an elective surgery.
Interview with P-1 on 12/11/2023 at 1025 revealed that after surgery, she noticed incorrect medications in her chart and her insurance coverage had changed, leading to billing errors. P-1 stated her primary insurance provider has been and is currently with Medicare/Medicaid.
P-1 submitted a grievance on 04/21/22. Review of grievance report dated 04/25/2022 revealed the facility addressed the issue and corrected the error.
However, further review of documents revealed ongoing issues. Document titled 'biller' notes printed by Staff K, dated 07/11/23 at 1518 states, "Went over this patient with supervisor during 1 on 1 yesterday. The Blue Cross/Blue Shield (BCBS) coverage does not belong to this patient. It is the same name and DOB (date of birth), but not her per the patient. Medicaid did remove it and claims were resubmitted and paid but they just recently put it back on again and are taking back payments and denying for COB (coverage of benefits/payment)."
On 12/11/23 at approximately 1100, an interview and chart review were conducted with Supervisor of Patient Access, Staff K. Staff K was queried to demonstrate P-1's current primary insurance provider. Staff K demonstrated that BCBS was primary insurer at the time of survey. Staff K was questioned if that was correct? Staff K stated that it was an ' error, ' according to the multiple biller notes present, and that it would need to be corrected by the complainant. Staff K then entered a ' billing note ' into the record, stating [Do not add BCBS]. Staff K stated that the coverage will again be terminated (when the biller sees the note) and demonstrated multiple ' biller notes ' present, that call for the termination of BC/BS due to error.