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For health plans and other healthcare organizations, quality measurement, risk adjustment, and reporting requirements grow more intensive as regulations related to healthcare reform become increasingly complex. Health plans are often challenged to meet these expectations in an environment that hasn’t kept pace with today’s demand for data.
Because many providers still maintain paper-based medical records, the process of obtaining critical member health information becomes a time and resource-intensive endeavor. Obtaining complete and accurate medical record information, reviewing and translating that data for use, and preparing the information for submission continues to pose challenges for healthcare information stakeholders across the industry.
Among the core complaints we hear from clients regarding medical record retrieval, locating multiple records for a single patient, slow turnaround times, and provider abrasion rank high. However, there are methods to streamline the process of retrieving medical records. In our experience, when multiple retrieval requests for multiple patients are batched and delivered—in one request—to the record custodian, provider abrasion can be minimized and retrieval times tend to improve. In addition, by keeping track of the success or failure of each request, retrieval experts are better informed the next time a request comes through for a specific location. Documenting each interaction is key to incremental process improvement across ongoing record retrieval efforts.
Having access to a well-trained staff is another core component of a well-performing quality measurement and risk adjustment program. Leveraging staff who understand the intricacies of government regulations helps inform retrieval efforts from the onset. Understanding the nuances of Medicare, Medicaid, and commercial plans in terms of risk adjustment, RADV audits, HEDIS® reporting, and other quality initiatives can have a beneficial impact when it comes to provider relations and the review process by requesting the appropriate information from the onset.
There are many ways in which requesting medical records can vary—and even more opportunities in how you manage the overall process. Provider “special handling” instructions can change across plan types, specialties, and requests. Identifying these types of special needs in advance of a project enables a team to best prepare for efficiency in record retrieval. By understanding how to match a request to a specific location, prioritizing retrieval requests by volume, managing multiple methods of receiving records, following up on outstanding requests, and processing incoming information, efficiency across each stage of the retrieval process can add up to significant time and cost savings for a plan needing to track down a high volume of data.
Another key success factor for optimizing retrieval efforts is visibility into the workflow of the entire process. When armed with the tools to track each stage of the retrieval process, health plans and other stakeholders are better informed of potential roadblocks and can quickly respond when additional interventions or approvals are necessary. Visibility and communication are major components that empower project stakeholders from start to finish. For example, Verscend’s scheduling and retrieval workflow process enables agents to request, aggregate, scan, and index patient clinical data quickly and accurately—and client users are given direct access to the retrieval system where they can track progress, check records, approve copy fees, communicate directly with retrieval exerts, and intervene to address barriers.
Collecting complete member medical record data is a key component to the quality, revenue, and payment initiatives that health plans face. Verscend’s web-based ordering system accommodates high-volume requests through direct data feeds, electronic files, or custom imports. Download our fact sheet to learn more about how we can help you support quality measurement, reporting and risk adjustment efforts with our medical record retrieval services.