Keeping track of the National Committee for Quality Assurance’s (NCQA) new technical specifications for the 2017 edition of the Healthcare Effectiveness Data and Information Set (HEDIS) released this July is hard enough without a slow medical record retrieval process.
NCQA’s update included four new measures, changes to seven existing measures, and the retirement of one measure—making it essential for risk adjustment and for HEDIS staff to be able to retrieve records effectively and accurately—not to mention quickly. Tracking 81 HEDIS measures across its five domains of care is a serious challenge under the best of circumstances. It’s important to have a workflow automation tool that includes end-to-end processing and audit protection. Revenue forecasting and help with quality performance are also essential.
To survive all the changes taking place in the post–Affordable Care Act environment, health insurance providers need competitive advantages, especially when it comes to medical record retrieval and positioning themselves for positive HEDIS scores.
Why is optimized medical record retrieval so important?
According to an article at ExpertLaw.com, record retrieval services have a major role to play. “These services support insurance claims agents by compiling a comprehensive health history of the concerned person so that the insurance company can [make] a proper payment decision on the basis of the medical records retrieved,” the article says. “In addition, payers can save costs associated with using in-house resources for requesting, tracking and managing the records.”
When looking for a workflow automation tool to speed up the medical record retrieval process, here are some tips to consider:
Make sure the tool has a complete workflow solution. Other products or services may perform one function well, but a complete workflow product that can perform chart collection, management, and reporting, with integrated audit functionality in a software-as-a-service solution is what it will take to speed the record retrieval process.
Be an early adopter. Don’t be closed-minded to new ways of doing things. The health plans willing to adopt new technology will see major benefits as they strive to survive in the shifting sands of today’s health insurance quality and risk adjustment regulations.
Be sure to get secure virtual printing (SVP) as an option. It’s hard to find a simple solution for sharing, retrieving, coding, and printing charts, but that’s exactly what’s needed in today’s market, including a way to virtually print records in a secure manner. A product that simplifies the chart retrieval process and allows for SVP is what it will take to optimize the HEDIS reporting process.
Make sure the product comes with expertise. Health plans that purchase a workflow solution should make sure that a team of experts comes with it. Access to extensive experience in the Medicare/Medicaid coding industry will greatly enhance the speed with which an insurance company can manage its risk and quality programs to drive revenue, improve quality, and ultimately increase its public-facing scores.
It’s difficult to obtain all the medical records that are needed for a HEDIS audit, let alone abstracting them correctly. Time is of the essence. Having a good retrieval system can speed up the reporting process by improving the data collected from the records.
Have you found a way to make the most of the medical record retrieval process?