Risk Adjustment

Effective Provider Outreach — The Linchpin for Successful Medical Record Retrieval

Efficient provider outreach is key to successful Medical Record Retrieval. Specifically, provider abrasion must be minimized. When choosing a vendor, payers should be mindful as to whether the vendor’s processes and workflows include techniques to reduce abrasion.

The questions below can help health plans ascertain whether a vendor has provider-outreach capabilities that will encourage timely and efficient record release.

  • Do They View You as a Partner to Resolve Obstacles?

Often, the success of a retrieval project depends on managing nonparticipating providers successfully. A vendor who views payers as collaborators in overcoming this obstacle is the required first step to customizing the best approach for a retrieval project.

  • Is Provider Outreach Customized and Monitored?

Vendors should work with health plans to create a communication plan for their provider community. Customized call scripts minimize provider abrasion. Additionally, vendors who actively ensure outreach quality by monitoring script adherence also have the advantage of identifying (and resolving) issues early.

  • Can Provider Preference Be Accommodated?

Does the vendor meet the needs of each provider by offering a suite of chart recovery options? Additionally, is provider preference considered alongside client preference and project status when determining the follow-up window? Vendors should be able to modify the follow-up by duly considering all relevant factors.

  • Does the Vendor Use Tools or Workflows to Maximize Retrieval Efficiency?

Prioritizing call center efforts to maximize retrieval speed and minimize provider abrasion will help smooth out a project’s moving parts by consolidating multiple member charts and tracking office-staff details and prior requests.

  • Do They Have a Deep Provider Network?

Vendors with extensive retrieval experience often have good working relationships (and up-to-date contact information) for many large provider groups. By pulling the history of all providers on a chase list, strategy can be customized specific to a project’s needs as well as to provider group size.

  • Is Data Validated (and Optimized) from the Start?

Data accuracy directly affects the ability to locate, retrieve, and code charts. Vendors who actively cleanse data to normalize and identify data risks will then be able to create the most strategic project plan (based on factors such as high-volume geographies and high priority providers)

Other advantages that data management provides include the capability to:

    • Schedule known, easy-to-retrieve locations for later in a project to maximize potential number of encounters / HCCs
    • Contact high-chart count providers well in advance of project start to re-establish working relationships and set expectations
  • Do They Have Specialist Roles for Important Functions?

With roles dedicated to functions such as project monitoring, ongoing training, quality assurance, and resolving providers not participating, vendors will be able to ensure that keys tasks are handled as efficiently as possible.

Before embarking on a medical record retrieval project, health plans should make sure they understand how a vendor answers the above questions. Doing so will go a long way toward the success of a retrieval project, as well as to ensuring positive working relationships with provider groups.

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