Is Provider Abrasion Bringing Your Medical Record Retrieval Rate Down?

Providers hold the key to successful
medical record retrieval.

This means that developing positive relationships and limiting abrasion must be a priority and a core competency for every record retrieval vendor.

Over the years, we’ve honed our processes and technology to deliver a 90% record retrieval rate. In some instances, we achieve 99%. Here’s how we do it:

Leverage technology focused on provider satisfaction

Our enterprise system cross references providers by identifiers, such as phone number, address, facility name, and provider name. This eliminates multiple requests and numerous calls to the same point of contact (POC).

Hire, train, and retain experienced staff

Our retrieval staff are Advantmed employees, not contractors or third parties, with at least two years of call center experience. All staff participate in extensive training, that includes call monitoring and shadowing. Compensation plans are designed to ensure high rates of both record retrieval and provider satisfaction.

Identify the right Point of Contact (POC)

We actively work to identify the appropriate POC for each provider, especially POCs for large provider organizations. For example, we carefully identify charts that roll up to a single POC for large providers to avoid sending multiple retrieval requests.

Employ a provider database system that includes isolated client-specific folders

This makes it impossible to confuse or combine client requests, call center outbound efforts, and MRT scanning work of multiple plans. This also ensures that the provider access portal only displays the records that are relevant to that client. 

Require a two-stage quality check

Our data staging and importing process Identifies duplicates, shared records, shared EMRs (across multiple sites) and validates provider contact data. This process ensures that we are calling the correct provider for the correct information the first time around. Further, when calls are made, we speak directly with the employee in charge of handling medical records for that provider location (i.e., the POC). 

Proactively identify provider issues

We train our outreach team to identify potential provider abrasion situations and report this to our provider management team. Advantmed subsequently quarantines such providers and assigns them to our specialized provider escalation team.

Manage complex providers appropriately

Our system has a sophisticated feature that identifies provider complexity and assigns specially trained call center staff to handle complex providers.

Want to Learn More?

We offer a suite of integrated risk adjustment and quality improvement solutions, including virtual wellness visits, health assessments, risk analytics, medical record retrieval, abstraction, risk adjustment coding, NCQA-certified HEDIS® measure software, and data validation.

Maximizing Your Quality Improvement Initiatives with Prospective Data Runs

What does the future hold for HEDIS® and your HEDIS results? No one can know for sure, but for quality improvement initiatives, prospective monthly runs can give you better insight and help you stay on top of results.

With monthly prospective data runs, health plans can monitor how each HEDIS measure and sub-measure is tracking towards a specific goal. Additionally, plans can conduct rolling 12-month reviews to track the status of year-to-date results (e.g., April 2019 to April 2020) to identify actual due dates of specific services to optimally focus outreach efforts.

Three Reasons Why High-Performing Plans Complete Prospective Runs

  1. Track trending towards goals, benchmarks, and/or last year’s submission results. NCQA’s new timeline for releasing HEDIS specifications allows plans to start improvement efforts and react sooner to new measures and measure changes.
  2. Create an off-season chart review project. During the project, medical record data can be collected for your HEDIS hybrid measures. In addition, we have a few administrative measure data collection forms that can be used to collect medical record data as well. This data is collected and then included with next season’s administrative data sources, reducing abstraction collection during the HEDIS season and maximizing administrative rates.
  3. Set targeted member and provider outreach efforts. With prospective monthly data runs, the most current gap lists can be sent to providers or used to coordinate with members to close gaps quickly to impact measurement year HEDIS rates.

To learn more about how prospective monthly data runs can benefit your quality improvement initiatives, email us or call 877.896.7350.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

HEDIS® 2020: What You Need to Know Now

Change can be stressful, especially when it comes to HEDIS®. With several updates anticipated in the coming months and years, you need to be prepared.

Advantmed’s HEDIS experts have been monitoring the National Committee for Quality Assurance (NCQA) and the market overall. Based on our research, we have summarized several important changes anticipated for 2020 and beyond, including:

  • Allowable adjustments
  • IDSS 2020–2021 redesign
  • Timeline specification changes
  • Digital measures

Additionally, and perhaps more importantly, we’ve provided a few key questions you need to answer to confirm that you’re prepared for this HEDIS season.

Review the changes and questions here.

Download our webinar, Best Practices: Three Key Steps to Minimize RADV Exposure

At Advantmed, we focus on helping health plans optimize risk and improve quality. Part of that preparation involves making sure you’re ready for a possible RADV audit.

Michelle Zilisch, Advantmed’s Director of Client Solutions, has been in the trenches with many health plans. In this seven-minute webinar, Michelle shares three key tactics you can employ to help minimize your RADV exposure.

During the webinar, you will learn:

  • Why having clean, complete data is so important – regardless of whether you’re audited or not
  • How thorough validation and review of your data will help you through a RADV
  • The important role a second-level coding review could play, and why it matters

This short webinar is seven-minutes long, but it could provide huge benefits should you go through a RADV audit.

Watch Best Practices: Three Key Steps to Minimize RADV Exposure today.