Risk Adjustment

The Who, What and Why of Copy Service Vendors

To many provider groups, the Release of Information seems to have zero return on investment. And yet, when it comes to risk adjustment, this is a myth. Medical record release is vital to:

  • Accurate member health profile documentation
  • Improved quality of care through disease management programs
  • Appropriate CMS risk premium

And yet it is not a myth that this tedious and time-consuming process can heavily burden provider groups’ financial and administrative resources. This is due not just to complex regulatory requirements, but also to the disruptive and costly nature of administrative staff attending to multiple vendors’ chart release requests.

To mitigate this, some provider groups utilize copy service vendors to handle chart retrieval. Payers who are unaware of these vendors (typically small and midsize payers, who may assume they are a downstream retrieval vendor) are sometimes surprised by the arrangement, as well as unaware of its potential cost implications to their retrieval project.

Chase lists can be viewed from (at least) two statistical vantage points. These are:

  • Location analysis: ratio of copy service vendor sites to overall sites
  • Chart-to-location analysis: ratio of charts that reside with a copy service vendor versus the chase list’s overall number of charts

When going by location analysis, the ratio of copy service vendor sites to overall sites may appear inconsequential: It’s not atypical for a copy service vendor site to represent five percent of a list’s sites. However, when calculating the ratio of charts that reside at said copy service vendor sites versus a list’s overall number of charts, that percentage often doubles, and in some instances, nearly triples.

In this light, the importance of copy service sites is now clear: Any locale with 10%-14% of a chase list’s charts is not insignificant. This is true from the perspective of a project’s chart retrieval rate, as well as from that of cost: whatever percentage of a chase list resides with copy service vendors represents additional cost on top of the retrieval fees already associated with those charts.

For this reason, health plans should be aware of the different payment options, as each has different implications for a retrieval project.

  • Pre-payment: Some copy service vendors will wait for an invoice to be paid before releasing charts. This option can delay retrieval, as the copy service vendor won’t start the process until payment is received.
  • Post-payment: Other copy service vendors invoice after releasing charts. Plans need to be aware that this option can mean unexpected fees. This occurs when payers are not informed that a copy service is retrieving records, and thus aren’t aware of costs until after retrieval*. (One strategy to avoid unexpected fees is to ensure your chart retrieval vendor both establishes copy-service payment thresholds upfront as well as proactively works to uncover copy service arrangements via its provider outreach call scripts as well as through historical provider group analysis.)

For payers, the copy service upshot is this: These vendors matter to your medical record retrieval project. Identifying their involvement as early as possible is vital to ensure success.

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Presentation @ RISE VBC: Effective Collaboration Strategies Between Payer & Provider

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