Risk Adjustment

3 Data Points to Improve Medical Record Retrieval Rates

Medical record retrieval is vital for risk adjustment, HEDIS scores, and CMS Star ratings. Yet the process is time-consuming, arduous, and costly, often resulting in physician abrasion and failure to retrieve charts. Fortunately, there are a few key pieces of information that make the process much smoother.

Medical Record Retrieval Challenges

Lack of consistency between the medical provider’s correct contact information and the actual location of the medical records results in incorrect information on the chase list and is one of the primary causes of poor retrieval rates.

Individual providers are typically not categorized by their medical groups, so the retrieval company spends countless hours calling multiple providers rather than contacting one location, like a hospital.

The first step, therefore, is to identify where the medical records are located and then the best point of contact for each of the providers’ locations. This may be the medical records department or the release of the information department.

Using Data to Locate the Medical Record Efficiently

Many health plans miss key data points that can improve medical record retrieval rates. Providing the retrieval company with these data points can help make the medical record retrieval process more accurate and efficient.

  1.    Tax Identification

Using the tax identification number on the chase list for each doctor and billing provider can also help identify multiple providers within the group and close data gaps.

  1.    Rendering Provider Address

Most chase lists include contact information for the rendering provider, the provider who saw the health plan member most frequently. Since most chase lists only include the provider’s address of record, the original claims data which contains the servicing address can help to locate a provider or a member.

  1. National Provider Identifier (NPI)

While a single National Provider Identifier (NPI) doesn’t always provide the best historical data about where medical records are located, combining it with at least one other key data point can be effective in triangulating a medical record location.  

Combining the NPI and the servicing address, the tax ID at the servicing address, or the NPI at a tax identifier provides a frame of reference to look at the historical data and find a phone number or address that can be used to retrieve medical records.

We find that health plans who use these additional data points achieve higher rates of medical record retrievals, save time, reduce physician abrasion, and realize higher profit margins.

To find out more about how you can improve retrieval rates, contact us today.

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