If you are reading this, chances are you agree with my previous blog’s premise that performing concurrent risk adjustment activities are increasingly important. Or perhaps you had already arrived at that conclusion previously.

Just wanting to do something is not enough, however. A concurrent review process is sufficiently different from a retrospective one to merit serious thought and planning. As we have been developing our platform and adapting our services, we have learned some valuable lessons. Here are some of the top obstacles and pitfalls to be considered when moving towards concurrent:

  1.  Data Flow: Having the right data to start with is critical. Aside from good suspecting and provider data, plans should take a Verify-Delete-Add approach. This means good encounter data is needed and the MRR platform needs to be able to handle that data to be useful.

  2. Provider Abrasion: Providers are bombarded with increasing numbers of chart pull requests. Provider abrasion is ever increasing as all of your competitors get into or increase the scope of retrospective chart reviews, especially now that commercial exchange plans also risk adjust. With concurrent, the frequency of chart requests goes up. It is critical to have an approach that does not further tax the already thin patience of providers.
  3. Taking Action: Aside from getting a clear picture of revenue and other aspects derived from medical records, a key aspects of concurrent review is gap closure. Tight review cycles afford plans the time to perform meaningful campaigns to close identified gaps.  Make sure you have a plan and the tools to act on the information to close as many gaps as possible.
  4. Cost: It stands to reason that more chart review cycles will cost proportionately more money. Money that may not be in the budget. What can you do? Tackle the two main cost factors in the MRR process: Retrieval and Coding. A lot of it can be done with technology, to the point that the providers are actually less bothered than before. And a new approach to coding based on the encounter, not the chart. The numbers are surprisingly different.

Whether you are using our platform, another vendor’s or your own workflow, these issues will be constants and deserve all our attention as we expect to adopt concurrent reviews more and more.

About The Author

Reveleer is a healthcare software and services company that empowers payers in all lines of business to take control over their risk adjustment and quality improvement programs. The Reveleer platform enables payers to independently execute and manage every aspect of provider outreach, retrieval, coding, abstraction and reporting – all under one single platform. Leveraging its technology, proprietary data sets, and subject matter expertise, Reveleer also assists payers with full record retrieval and review services to support financial performance and improved member outcomes.