https://info.cotiviti.com/hubfs/blog_HEDIS_2019_chase.jpg
QUALITY IMPROVEMENT

From the HEDIS® 2019 trenches: optimizing your chases

The countdown to the HEDIS® 2019 reporting deadline is well underway. Are you on track? Our Cotiviti experts are here to share their insights on effectively managing your measurement and reporting process in our monthly blog series, “from the HEDIS 2019 trenches.” Here, program manager Leah Breeggemann offers insight on optimizing your chart chasing efforts.

Mapping the way

Before you send your chase data to your retrieval vendor, it’s critical that you have it in the required format and in good order. With only about 10 weeks to retrieve charts, any small misstep could lead to costly wasted time and effort that will directly impact your scores.

For example, do you want records to be chased for emergency room providers, chiropractors, and radiologists? Will these locations give you the records you need to improve your hybrid measure scores? If not, make sure the chase flag for these providers is turned off.

Another key area to pay attention to is provider location and contact information. Claim data doesn't have the best track record when it comes to giving you an accurate location, phone, or fax number for a clinic or provider. Pull in provider location and contact info that you compiled last year so that you can be sure you’re giving your retrieval vendor the right information and reduce wasted effort. Keep in mind that you need to provide the provider’s actual location, not where the claim was billed from.

Make sure your provider contact information is also “normalized” for consistency, looking at the format of street names, abbreviations, suite numbers, and phone and fax numbers, for example. The more consistent this data is, the easier it is to find locations that can be merged together to reduce the number of times your vendor will have to reach out to a particular provider. Similarly, if you’re able to merge any providers who work at the same clinic together on your end, or merge common locations together, your vendor will have fewer phone calls to make to the same office.

Optimizing efficiency

Once you complete your test run, use it to assess how effective your provider and location clean-up efforts have been, then do additional clean-up as necessary. Also be sure to pay attention to your unassigned member count (the number of members who have no chases assigned to them) and apply additional chase logics to lower that rate. Remember: for any members who have no chases assigned to them, you literally have a zero percent chance of making them compliant.

The more effective chases you have, the better chance you have to collect more data, which directly translates into better scores. A chase isn't an exact science—it’s more like an educated guess, aimed at finding the most logical location where a specific member’s medical record that will have the information you need is stored.

With that in mind, after you complete your test run, it’s time to re-evaluate and re-prioritize your chase logics. Cotiviti provides our clients a chase priority report to accomplish this goal. If one chase logic yields a lower chase count than another, make it a lower priority. In addition, we have a chase effectiveness report, helping you examine last year’s data to determine not only which chase logics were utilized, but which ones actually returned results that made a measure numerator compliant.

Staying the course

Once chart retrieval begins, pay close attention to the number of records coming in and calculate the difference between records expected versus records delivered. Monitor the measure goals that you've set—maybe you’ll need to prioritize a certain measure over others for the best results. If certain products have more weight for your organization, prioritizing chases by product could also make the most sense.

In addition, certain provider locations will require a copy service to come on-site in order to retrieve records. Make sure to prioritize these chases, as they’ll require additional time to complete. And be sure to review and enforce any agreements you may have in place with providers regarding record collection. If your contract with the provider says they must provide a record free of charge, don’t pay for them.

Finally, evaluate your internal deadlines as record collection progresses and adjust them, if necessary. If you were planning on ending record collection on May 1, but you could extend that to May 4, this may yield valuable last-minute records that will increase your hybrid measure scores.

 

Quality measurement and reporting is tough—and the last thing health plans need during HEDIS season is a vendor that makes it tougher. Learn more about Cotiviti's customer support excellence, powerful software, and resource-efficient services from our Quality and Performance solutions overview.

Read the overview

 

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

WRITTEN BY

Leah Breeggemann
For the past six HEDIS® seasons, Leah Breeggemann has served as a program manager in Cotiviti’s Minnesota office. Her main responsibilities are assisting our clients in successfully submitting their data to NCQA in order to improve the client’s measure rates by participating in data analysis and quality assurance. Leah earned degrees in theater and business from Gonzaga University.

Read More

QUALITY IMPROVEMENT

From the HEDIS® 2019 trenches: optimizing your chases

Leah Breeggemann

Feb 20, 2019

Write a Response