So many medical records to retrieve. So little time to retrieve them.
Obtaining every relevant record possible, abstracting them correctly, and producing reliable results for your annual HEDIS audit always seems to require more time and effort than the deadline allows.
Already a complex process, retrieving medical records for a HEDIS audit is further complicated by challenges like:
- Lack of interoperability between EHR/EMR systems
- Inability to both retrieve and extract useful data from those charts in order to improve the accuracy of diagnosis and quality care; and
- Providers who are ambivalent, unwilling or unable to provide the records you need, when you need them.
But you can provide the highest-quality care possible—and prove that you are doing so. Follow these best practices for HEDIS audit medical record retrieval (MRR) to maximize HEDIS rates for hybrid measures.
Prepare your systems
Your retrieval and abstracting of records will be most efficient when your software and workflows are configured correctly. To start, verify the HEDIS® certification of any vendor software and implement it properly, testing its performance before ramping up retrieval. Then test interfaces between NCQA-certified vendor software and MRR-vendor software to ensure that records will flow smoothly. Last, confirm the accuracy of existing provider data and do sample data runs.
Prepare your vendors
Create a collection strategy with your vendors; define roles, set expectations, and address potential issues like known problem providers. Establish timelines for on-site retrieval as well as plans for remote retrieval through electronic medical record (EMR) systems. Be sure to schedule your efforts to coincide with providers’ availability and confirm that your internal and external team members are aware of the plan and their respective responsibilities. The best strategies are developed several months in advance, and are fine tuned closer to the HEDIS season.
Prepare your approach
Craft a request letter that details the records you will be seeking, as well as when, how, and why you will need to receive these records for your HEDIS audit. Specify the parts of the medical record that you will request and the preferred method of delivery (i.e. fax or remote ERM retrieval), And run your letter through your legal team to avoid missteps. Standardize your script for calls that will be made to providers as well; this, too, should help you gain cooperation from providers while avoiding any potential legal problems with requests. Determine if providers will have specific authorization forms that you will need to complete and, if so, plan to do so, like perhaps by including a facility code to distinguish between care settings.
Prepare your providers
Start notifying your providers of your upcoming retrieval efforts at least two months in advance, with regular reminders leading up to the start of the collection process. They too will need time to prepare their staff and systems. Account for the different methods of retrieval that they can accommodate, like print-to-scan or encrypted flash drive on-site or fax or mail off-site. Tell them the demographic data and HEDIS measures that you will require and notify them of any vendors who will be contacting them on your behalf. Provide them with contact information for you and/or your vendor and encourage them to share any questions or concerns so that you can address them and move on, thereby keeping the retrieval process flowing.
Best practices for HEDIS audit MRR begin well ahead of the HEDIS season. Preparing your systems, vendors, approach and providers in advance will help you maintain quality, compliance and adherence to deadlines. Doing so will allow you to submit the annual HEDIS project on time for all lines of business and ensure successful outcomes.
