Podcast: Are you ready for medical record review validation?

The HEDIS^® deadline for submitting your medical record review validation (MRRV) data is earlier this year. Are you prepared? On the latest episode of our “From the Trenches” podcast, our monthly dive into HEDIS 2018 continues as we get tips for MRRV success from Carrie Taylor and Holly Conk, who oversee Cotiviti's HEDIS abstraction team.

Listen here as they discuss: 

• How the MRRV timeline is different for HEDIS 2018
• What you should be doing now to prepare for next month’s MRRV deadline
• Best practices for working with your HEDIS abstraction vendor

From the Trenches is a new podcast from Cotiviti Technologies, a leader in healthcare data analytics, exploring the latest trends in healthcare quality and performance analytics, risk adjustment, payment integrity, and payer-provider collaboration. Check out all our episodes in your browser, or subscribe on your smartphone or tablet with Apple Podcasts, TuneIn, Google Play, and Stitcher.

About our guests:

In her role, Carrie Taylor has shaped the model for Cotiviti’s abstraction team and led growth in client satisfaction and abstraction volumes. Carrie has been a Registered Nurse for 15 years, with clinical experience in cardiology as well as management in a variety of healthcare settings. She holds a bachelor’s degree in nursing from Emory University and master’s degrees in business and healthcare administration from the University of Utah.

Holly Conk is responsible for managing the hundreds of staff that complete abstraction each year. She has developed a methodology for pre-hire testing that helps determine the best candidates for the position, and her leadership has led to a strong retention rate year after year. Holly has also helped to develop processes to increase efficiencies in production and minimize errors. She has been a Registered Nurse for six years, with clinical experience in OB and outpatient surgery as well as management in healthcare settings, and holds a bachelor’s degree in nursing from Ameritech University. 

Podcast transcript

Let’s start off with a quick recap of what medical record review validation or MRRV is—tell us the details. 

MRRV stands for medical record review validation, and is the time of the season where we review compliant medical records to ensure they are correct. At the end of the medical record review period, auditors will select one numerator from each of the five groups. They will then randomly select 16 medical records that are compliant for this numerator to review. We usually start overreading compliant samples the last two weeks of the season to increase the number of records that have been overread before going to the auditor.

What’s different about the MRRV process this year for HEDIS 2018 than in years past? 

This year the timeline for medical record review was shortened by one week. Previously, medical record review ended around May 15, but this year it’s ending on May 9. This leaves us less time to collect and review records, and shortens the timeframe for MRRV. It also means that we have started our MRRV process while still trying to review new medical records.

How should health plans prepare for MRRV before medical record review begins? 

Prior to the start of the season, health plans should review their prior year audits. You need to assess any issues you had in the previous season, any errors during audit, and new measures for the upcoming year. For example, if during the previous season you struggled with taking dated problem lists as undated problem lists, you may want to focus on the CBP diagnosis for this HEDIS season. Having a preliminary plan at the start of the season will help you focus on your end goals from the start.

How should health plans be preparing for MRRV this month? 

This month, plans should finalize their plan of attack for MRRV. By now most plans have submitted their convenience samples and have feedback from their auditors. This, along with current rates and quality, should be taken into consideration. Select the numerators you are going to focus on, and adjust resources from abstraction to overread if needed.

What are the most difficult challenges that health plans face in getting ready for MRRV? 

The biggest challenge is the unknown. There are 35 numerators between five groups, and if a numerator is selected that you did not focus on, you could be at risk. This is why a pre-season plan and mid-season assessment are so important.

What are some MRRV best practices for working with your HEDIS abstraction vendor? 

Communication about your goals is key to success. You want to make sure your vendor knows your pain points, concerns, auditor feedback, and overread goals. It is also important to communicate where you as a plan are focusing your overreads in order to divide and conquer. 

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

Podcast music credit: "Inhaling Freedom" by Nazar Rybak, via HookSounds.