Improve your quality by partnering with Episource. We assist health plans during HEDIS season with medical record collection and abstraction for accurate reporting on HEDIS rates. Our abstraction team is comprised of RNs/LVNs, certified coders, and clinicians who are experienced in abstracting medical records for Medicare, Medicaid, GPRO, and Commercial HEDIS measures. Benefit from robust reporting and analytics tools designed to evaluate your performance with different quality measures for Medicare, Medicaid, ACO, and Commercial lines of business.
Our Quality Platform delivers interactive dashboards and reports that assist you in quickly identifying trends in performance. Utilize this data to advance the quality of care your patients receive, thereby improving your quality ratings. These reports detail year-over-year trends, as well as comparisons to industry benchmarks, to help you classify which measures need immediate action for the coming year. The reports can be viewed at multiple levels (e.g., Plan, medical group, clinic, provider).
We have designed this platform to help improve your HEDIS compliance rates to meet your goals. Benefit from report rates at the provider level to provide them with actionable Gaps in Care reports that can be used to call members for needed services.
Weekly updates on abstraction and over-read status
Status reports (e.g. hybrid compliance rates by numerator; number of completed records by compliance status, pending records, records in progress, exclusions by measure)
Review of critical records/questions that require auditor feedback
Discussion with technical experts to formulate questions for the auditor on records that can be potentially considered as compliant
Ad hoc meetings to address any issues that come up during the HEDIS season
Experience with all CMS and State-required measures
Work with auditors to resolve issues on any records to maximize HEDIS rates
Vigorous primary, secondary, and tertiary pursuits processes to maximize HEDIS rates
STRATEGIC QA ASSIGNMENT
Quality control all scanned records; assign to record review teams for abstraction
RESULT FILES TO HEDIS SOFTWARE
Integrate abstraction result files (using written scripts) into Client HEDIS software systems
MRR VALIDATION AUDITS
Provide over read services during Medical Record Review Validation Audits when plans and measures are selected by an Auditor
STRATEGIZE RETRIEVAL EFFORTS
Retrieve all medical records from Chase List which will have provider/member/measure details (schedule appointments with facilities, retrieve record onsite/fax/mail/EMR Download/Provider Upload)
REVIEW CHARTS & ABSTRACT DOCUMENTED SERVICES
Utilize clinical abstractors to review each chart and abstract the documented services as specified by the current HEDIS Volume 2 Technical Specifications using Auditor approved abstraction tools