Description
Responsibilities
The Compliance Professional 2 has responsibilities for performing clinical audits on medical record documentation for quality and clinical compliance with contract requirements as outlined in the Autism Care Demonstration (ACD) policy, TRICARE Operations Manual (TOM) Chapter 18 Section 4. Reviews shall compare the beneficiaries' session notes to the provider's claims to determine whether all required documentation exists and is adequate to support the submitted charges. Comprehensive medical reviews will be conducted on applied behavior analysis providers' claims for specified ABA CPT Codes.
KEY ACCOUNTABILITIES
95% Quality Monitoring
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