Why the Scoring Mechanisms of Medical Decision-Making are Flawed
By Shannon DeConda| May 10, 2018
The scoring mechanisms of the MDM are suggested tools, not rules or laws.
In our last article we explored how time in conjunction with medical decision-making (MDM) must support the same level of service, and why that rule makes sense. However, we were left with a puzzling consideration in regard to MDM, and here is why: The scoring mechanisms of MDM were created through the Marshfield Clinic Guidelines (MCG). So, let’s consider any relevance MCG has on our current audit process.
We should start at the beginning. Marshfield Clinic was a large clinic in Wisconsin. The group was multi-specialty and included many locations. During the creation of 1995 Documentation Guidelines, the group’s Medicare Administrative Contractor (MAC) approached them and asked if they would beta-test the guidelines. The clinic quickly identified that while the history and exam components included some sort of qualification system, the MDM did not have such a scoring algorithm. Therefore, the clinic created its own internal MDM guidance.