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Now that we have a second season with the new medical record review validation (MRRV) guidelines under our belts, were you better prepared this year? In the latest edition of our blog series, “from the HEDIS® 2017 trenches,” Carrie Taylor, Verscend’s manager for HEDIS abstraction, discusses what Verscend did this year to ensure MRRV success for our clients, and offers tips for health plans performing their own abstraction and over-read.
Where are health plans in the HEDIS process now that we’re nearing the end of the season?
We just completed MRRV, which entails the plan’s auditor selecting 16 compliant samples for one numerator in each of the six HEDIS measure groups to audit. This step is one of the most challenging of the season because the auditor no longer tells the plan which numerators will be reviewed in advance. Instead, selection is based on new or revised measures, complex measures, or measures that the plan struggled with in previous years.
What should health plans with MRRV issues this year do to pass with flying colors next year?
Focus your over-read efforts on measures you think are most likely to be selected. In an ideal world, you could perform 100 percent over-read on all numerators throughout the entire season, but most health plans don’t have the resources it would take to do this.
We recommend the following strategies:
Start over-reading early
By starting over-reads early in the season, you can catch trends in errors as well as decrease the burden in the final two weeks of the season. This season, Verscend’s abstraction team began increasing over-read rates in early March to meet our clients’ MRRV goals.
Make a plan
Having a plan of attack for MRRV early in the season allows you to staff appropriately for over-reads later in the season. It also allows you to evaluate prior-year MRRV selections, new measures that have been added to the plan, and trouble spots from previous years, and it enables you to work closely with your auditor. Throughout the season, your plan may change, but it’s important to have a starting point, clear goals, and a thoughtful timeline. We usually see clients choose one of three strategies for MRRV:
Watch seasonal trends
Finally, keep an eye on the quality of abstraction throughout the season so you can retrain or remove abstractors who are not meeting your quality goals. You also need to watch for trends in errors and address the underlying causes. Listen closely to your auditors’ feedback regarding medical record review. If they have concerns in certain areas, you may need to re-evaluate your plan.
What are some best practices for working with your abstraction vendor during MRRV?
Communicate with your vendor as early as possible about prior-year selections, new measures, measures you have historically struggled with, and your convenience sample. Work with your vendor to choose which over-read strategy makes the most sense for you. Once you choose, make sure you re-evaluate frequently based on quality scores, pain points, and auditor feedback. Don’t get so attached to your plan that you’re missing red flags during the season.
We hope your second HEDIS season under the new MRRV guidelines was a success. It’s never too early to start preparing for next season.
Stay tuned in June for our final report “from the trenches” for the HEDIS 2017 season.
Interested in learning more about how Verscend ensures abstraction success for our Quality Improvement clients? Download our fact sheet for details on our rigorous training and QA processes.