If a chart reviewer finds that a member had two negative FOBT tests, what is the next step?

When a chart reviewer discovers that a member has two negative fecal occult blood tests (FOBT), the next step should be to seek documentation confirming whether a third FOBT sample was completed. The rationale for this action is rooted in the guidelines for screening and monitoring for colorectal cancer, which typically recommend multiple tests to ensure accurate assessment and ongoing patient safety.

The presence of two negative results may be indicative of an absence of disease; however, medical guidelines often necessitate the collection of additional samples to maintain a consistent screening approach. This is especially true in managing patient care effectively, as sometimes a single negative result may not be sufficient for a clear screening outcome. Therefore, confirming a third sample allows healthcare providers to make informed decisions regarding the member's health monitoring and necessary follow-up care.

Additionally, stopping the review or marking it as complete would not provide a comprehensive view of the patient's screening status, as two negative results alone may not fully satisfy the necessary evidence required for compliance with HEDIS measures related to colorectal cancer screening. Requesting additional records could be an option, but it may not be necessary if the institution's guidelines typically rely on documented FOBT screening outcomes. Thus, verifying the existence of a third sample becomes the most logical and thorough course of action