Confidentiality is vital to the quality of care and service provided to our members. We will respect and maintain the confidentiality of all discussions, records and information generated and accessed within the confines of my day-to-day job responsibilities. We also agree not to discuss confidential information except to persons authorized to receive or review such information.
We affirm that:
- UM decision making is based only on appropriateness of care and service and existence of coverage
- Serra Medical Group, Inc., does not specifically reward practitioners or other individuals conducting utilization review for issuing denials/deferrals/modification of coverage or service.
- Financial incentives for UM decision – makers do not encourage decisions that result in underutilization.
- SCMC does not use incentives to encourage barriers to care and service.
- Medical Management Program description, policies practitioner contracts must not contain language indicating improper utilization incentive programs. Terms under which a practitioner may be entitled to a bonus or incentive pay cannot influence a practitioner’s decision to withhold, delay, or deny necessary service.
- Practitioners are ensured independence and impartiality in making referral decisions that will not influence:
- Hiring
- Compensation
- Termination
- Promotion
- Any other similar matters
Serra Medical Group, Inc distributes this statement affirming that UM decision making is based only on appropriateness of care, service, and existence of coverage. Serra does not specifically reward practitioners or other individuals for issuing denials of coverage or service care; financial incentives for UM decision makers do not encourage decisions that result in underutilization. Serra Medical Group distributes this statement to all staff, including:
- Practitioners
- Providers
- Employees
- Enrollees
Signs are posted (English/Spanish) on every floor. Website and paper copy available upon request. Serra will mail it affirmative statement about incentives to recipients who do not have fax, email or internet access.
Practitioners and staff sign affirmative statements annually during QI meeting.
