Modeled on a healthcare BPO documentation QA workflow
- Track
- Documentation Review
- Difficulty
- Easy
- Time
- 12 minutes
Renato Deshpande is 61, covered under Calloway Preferred PPO through Lakeview Transit Authority. S. Adeyemi, NP ordered home oxygen concentrator, rental - 17 months over 02/10/2027 to 07/03/2028 - for chronic respiratory failure with hypoxia (J96.11). It reached your documentation review desk on 02/01/2027. The oxygen renewal packet holds S. Adeyemi, NP's brief summary of 01/31/2027, which gives history only, and an order for the concentrator that carries her typed name but no signature or date. The plan's policy UM-CP-733 needs a current signed progress note before review, due 02/08/2027. The chart index shows a progress note from the same 01/31/2027 visit, not yet in the packet, which documents a resting oxygen saturation of 86%, failed attempts to wean, and functional decline. The decision is due 02/08/2027, 7 days from the day the plan logged it in. Your job is to gather, verify, record and route. The clinical decision belongs to the licensed reviewer who owns it.