HOW TO REDUCE PROVIDER ABRASION DURING THE RADV/IVA AUDIT PROCESS

Reducing provider abrasion can help you retrieve, code and submit data more quickly and accurately; because if you can help a provider, then they are more likely to help you.

Picture yourself as a provider.

You’re caring for patients when a payor requests medical records to help them meet a deadline.

Then you receive another records request. Then another. And then, yet another.

Soon it feels as if you spend more time processing payors’ requests for records than caring for patients. Would you be eager to help the next payor who asks for records?

As someone responsible for collecting data for risk adjustment, your next request could be the one that forces a provider to draw the proverbial line in the sand, telling you, perhaps politely or perhaps not, that you will have to wait for your records.  

So, whether you are representing a Medicare Advantage plan selected for a risk adjustment validation (RADV) audit or a Commercial Health Exchange (HIX) plan preparing for an initial validation audit (IVA), reducing provider abrasion will help you comply with deadlines and data requirements by speeding the retrieval, testing and validation of records.

Follow these steps to reduce provider abrasion during the RADV/IVA audit process:

1) Assess providers’ retrieval capabilities.

The fax machine no longer epitomizes cutting-edge technology. But it may be the best choice, if not the only one, that a physician’s practice or other provider may have for sending records to you.  

Determine whether your providers have only paper medical records, a full-integrated electronic medical record (EMR) system or something in between. Then assess their proficiency in using the systems they have in place.

A large practice may have a powerful EMR but the provider’s team must know how to use it properly to maximize its efficiency. Identify any gaps in technology or proficiency among your providers and educate them on ways that they can be more efficient, like by learning more about complying with medical record documentation requirements.

2) Facilitate retrieval remotely

Consider investing in innovative medical record retrieval options that allow provider offices to remotely send medical records directly from any EMR or electronic source by simply clicking ‘PRINT’.

If a provider insists on sticking to the fax, enable them to send charts right to a secure virtual network, from which your plan can abstract the data you need. Similarly, they could mail charts to you or let you send a field technician tc copy them into a secure laptop so that you could then process the data through your network. This would lighten the burden on the providers while speeding processing for your plan.

3) Learn their processes.

Providers may have preferred ways to receive MRR requests. Learn them and abide by them because a practice will follow its release of information process instead of accommodating yours. You can send all of the requests you want to a fax number but you will only be wasting time if nobody is watching the machine and the practice’s website directs you to submit a request through it instead.

4) Coordinate requests.

Few inefficiencies gnaw at providers like when different departments from the same payor request the same information. Duplicate requests waste time.

Establish internal claim identifiers so that departments can tell if records have been retrieved and reviewed before they request that same information from the provider. Sharing the results internally will also allow you to preserve your provider relationships externally.

Limit your requests to a manageable amount of claims as well so that providers do not have to overwork their people and processes, especially if you may not need all of the data that you would collect.

5) Communicate early, clearly and often.

The earlier you can get a request to a provider, the more time you have to overcome any obstacles that may arise. Keep providers apprised of your deadlines so that they know when you may request information—and tell them how you will do so. Craft a detailed request letter as part of your MRR preparations. Specify the parts of the medical record that you will request and the preferred method of delivery (i.e. fax or remote ERM retrieval).

Remind providers of upcoming deadlines repeatedly. 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. Collaborate with the provider’s team. Treat them as if they are your best customer, doing whatever you can to make their jobs easier.

Following these five steps to reduce provider abrasion during the RADV/IVA audit process will improve your MRR workflow, thereby allowing you to preserve revenue integrity by compiling and submitting complete, accurate and timely data.

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.