Risk Adjustment

Are Your Records Being Held Hostage by Copy Service Vendors?

How much of an impact can copy services have on retrieval rates? More than sometimes realized. Especially considering that many small and midsize health plans are either not aware of them, or assume they are a downstream vendor of the medical record retrieval vendor: “I am paying you for retrieval, why are you going through a copy service to get my charts?”

Given that many providers will only work through copy service vendors, successfully managing copy service relationships is vital to maximizing retrieval rates. To ensure the most effective and efficient outreach effort and the highest retrieval rate, vendors should have a comprehensive copy services strategy to mitigate the lengthy retrieval timeline. Copy services require on average 10-12 weeks for retrieval, an unrealistic timeframe for most payers.

What are copy services vendors, and how they work

The following vendor capabilities will help ensure that copy services don’t hold your retrieval project hostage:

1. The Ability to Help Payers Avoid (or Lower) Copy Service Fees — Vendors can proactively check if an onsite or remote team can be utilized in lieu of copy services. Sometimes, even where providers initially request fees, the charges can be avoided by explaining that the request is due to CMS requirements. When this is the case, thousands of record fees can be averted by lowering or negotiating copy fees to zero

2. Partnerships and Strategic Alliances — A vendor with national partnerships and negotiated pricing with copy services can leverage its experience to handle all pre- and post-payments to medical providers (as necessary for copying costs, etc.). Additionally, strong working relationships are especially helpful given that groups / providers that use copy service vendors can be identified on or before project starts, increasing chances of high retrieval and potentially avoiding additional fees (some copy services will retrieve charts with fewer than 10 weeks’ notice but levy a premium).

3. Establish and Monitor (Adjusting as Necessary) Provider/Copy Service Fees Thresholds — Where a provider or copy-service vendor insists on a fee, a vendor should make sure it is below a Plan’s thresholds while keeping plans updated about the fees and events throughout the project. For example, locations sometimes possess critical records that justify paying above the threshold. Payers may address these from the start or vendor may identify these.

4. API Electronic Medical Record Capability — This level of access can enable health plans to efficiently perform multiple chart audits per year, and in some cases allows them to work around large copy-service vendors and avoid associated copy fees, eliminating or reducing lengthy retrieval timelines.

By choosing a medical record retrieval vendor with the above capabilities, a payer’s retrieval projects will be one step ahead, even before a project starts.


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