Provider-chart retrieval and risk-adjustment coding reviews used to be time-consuming, occasionally antagonistic, projects. Providers were suspicious of payer representatives in their practice or department digging through charts and analyzing documentation, while payers struggled to find the charts they needed to accurately calculate risk scores.
Two major trends in the healthcare industry are changing this process from adversarial to – almost – collaborative: electronic health records (EHRs) and value-based payment models. EHRs make chart retrievals faster and easier for both parties, while value-based payment models help provider organizations better understand the importance of risk adjustment and its growing impact on their reimbursement.
Even as the process becomes more harmonious, the following are three tips to ensure your next chart retrieval and risk-adjustment coding project is efficient and beneficial for all stakeholders.
1. Automated steps. With EHRs in at least three out of four hospitals and 83 percent of office-based practices, reviewers may not even need to be in the facility to review charts. With the proper disclosure authorizations, payer representatives can abstract the needed information from the EHR through a secure web browser or through special access on a secure virtual private network.
2. Client portal. If you plan to retain a partner to assist with the chart review, ensure the firm offers an interactive portal that offers real-time transparency into the progress at each stage of the project. Essential functionality should include: the ability to view provider participation, clinical review progress, and quality reviews, as well as the ability to conduct coding overreads, download chart images and generate reports. This oversight will ensure the organization receives the data it needs in less time and with less disruption for the providers.
3. Longevity and experience. With the healthcare industry’s growth, there are many new firms or expanded divisions of large corporations offering chart retrieval and risk-adjustment coding review services that lack knowledge and experience in these critical projects. Issuers should only consider firms whose experience with these services date back to when all providers used only paper records. Also, the firm’s reviewers should be American Health Information Management Association or AAPC-certified coders who have deep expertise in capturing or deleting risk-adjusting diagnostic codes and performing data validation audits.
These are only a few considerations for your next chart retrieval and risk-adjustment coding project. To learn more about how your organization can capture missing diagnoses and ensure members are appropriately risk adjusted, click here.