With the January 2020 submissions deadline right around the corner, many health plans, particularly those with limited resources, are in the midst of a major push to complete their medical chart retrieval projects and maximize their risk adjustment programs and financial performance.
The overall success of any medical chart retrieval project depends on several key factors. For starters, shorter projects will always have lower retrieval rates than longer projects since many providers’ offices typically aren’t working on the same timeline as health plans would prefer. Also, projects that start later in the year regardless of length tend to underperform because many providers and copy service providers use first in, first out processing. Therefore, since larger, more resourced, health plans start earlier in the year and have larger chase lists, smaller health plans will be at the back of a long line.
Despite the challenges health plans are now facing, there are several ways to maximize medical chart retrieval, streamline the process from analytics to submissions, and optimize risk adjustment performance before the January deadline. Here are 5 tips to consider.
1. Ensure accurate provider grouping
The best-case scenario for a chase list is when providers are at the same address so it’s only necessary to make one call. There may be providers that work for a medical group with a centralized records department such that the charts for many providers working at multiple addresses can be retrieved from a single phone number or address. However, in some cases, providers at the same address aren’t affiliated and don’t use the same EMR system which ultimately requires the charts be retrieved separately.
The key to maximize medical chart retrieval therefore, lies in accurate grouping. When you know the correct numbers to call as well as which records and how providers are grouped across or within addresses, the chase results will benefit. Higher retrieval rates indicate a more informed and accurate chase.
The best way to ensure accurate grouping is to use prior data. Analytics vendors have robust prior data from past retrieval projects which allows them to catalog the best retrieval method for each organization and address. Prior data enables plans to understand where to call in order to retrieve from the entities, servicing addresses, and providers in a chase list.
2. Prioritize providers for medical chart retrieval
If you have 5,000 providers on a chase list, it’s vital to have a clear strategy about which providers to call first as well as the order for follow-up—a strategy that should be built on data. Before creating your strategy, you should consider that the slowest and lowest reliability component of any chase are the large copy service providers which tend to be overly busy the closer it gets to the end of the year. Health plans who decide to work with copy service providers should submit their chase lists with as much lead time as possible. However, they should also keep in mind that many vendors have the highest risk of failure this time of year and often do not to come in by the deadline.
With complete access to analytics data, it’s significantly easier to identify if a provider uses a copy service. That information makes it possible to direct the chase list to the copy service provider upfront and possibly eliminate the need to call the medical provider’s office altogether. Analytics data also allows you to identify and prioritize the providers who don’t have a copy service but are slow to respond to chart retrieval requests along with the historically non-participatory providers.
3. Take stock of your vendor’s coding capacity
A common challenge health plans face is a lack of time for coding. When evaluating vendors, it’s important to work with one who has the bandwidth to code charts even if they come in the morning of the client deadline. The vendor should be able to code the charts within hours, not days or weeks. This is particularly important at the end of the year when hundreds of charts for an audit are coming in until the very last minute.
4. Set cost-per-chart guidelines
If you choose to work with a medical chart retrieval vendor, it’s imperative to establish from the get-go how much you’re willing to pay copy service companies or providers who request a fee for medical chart retrieval.
Oftentimes, there are delays which can occur for a week or more at a time, placing providers on hold while the vendor waits for approval from the health plan. When there are pre-approved fee limits in place, payment and retrieval can occur while the vendor has the provider on the phone.
While many plans agree to $25 per chart, that amount typically creates more exceptions, or instances in which a provider asks for a higher fee. Setting a higher initial approval limit between $25 and $35 per chart allows you to maintain the momentum and minimize the exceptions without spending too much. Although there will be exceptions at a higher rate, it’s still worth it to most health plans to approve them.
5. Assign an internal dedicated network manager
Health plans that have the most success with medical chart retrieval at the end of the year have at least one team member dedicated to collaborating with their vendor. A network manager’s accountability makes it easier to resolve issues that lead to delays such as providers not participating. In the first few weeks of the project, regular calls are necessary but even when a network manager is up to speed, the health plan should still have full transparency into the process. A reliable vendor will enable their point of contact to review and resolve issues and manage interventions on the fly.