Medical Record Retrieval & Review

Transcription

1 Healthcare Effectiveness Data Information Set (HEDIS) Medical Record Retrieval & Review Measuring quality of care and services provided to our members! Date: January 19, 2016 Partnership HealthPlan Presenter: Megan Wilson, Project Coordinator II, HEDIS ECS Presenters: Steve Densley, Business Development

2 Objective Overview of HEDIS What s New for HEDIS 2016 Medical Record Retrieval Process Upcoming HEDIS Events Resources Q&A

3 HEDIS Overview What is HEDIS? Healthcare Effectiveness Data Information Set Administrative vs. Hybrid Measures Why is HEDIS Important? Evaluates clinical quality in a standardized way Identifies opportunities for improvement Regional level performance is publicly reported Regional reporting is required by the State

4 HEDIS Overview Southeast: Solano, Yolo, Napa Southwest: Sonoma, Marin, Mendocino, Lake Northeast: Lassen, Modoc, Siskiyou, Trinity, Shasta Northwest: Humboldt, Del Norte PHC Internal Use Only

5 What s New for HEDIS 2016? First year partnering with MRG, Medical Record Abstraction Vendor Prescheduling Medical Record Retrieval, with our 2 nd year partner; Enterprise Consulting Solutions (ECS).

6 2016 HEDIS: ECS Retrieval Process 8

7 Agenda About ECS Security and Compliance ECS Field Technicians Retrieval Process Methods of Retrieval Provider Package Best Practices 9

8 About ECS Proven to Scale. 65,000 provider sites and 2,500,000 chart requests annually. Reliable & Experienced. Currently serving 7 of the top 10 largest Health Plans in the U.S. On site retrieval. More than 2,500 field technicians in all 50 states. On shore. All operations are on shore, including our call center. Robust Technology. 24 X 7 real time access to status of record requests. Flexibility. Ability to ramp to any project quickly. Highly Secure. Industry leading HIPAA compliance adherence. We will deliver on our commitments 10

9 Security & Compliance 100% Commitment to Zero PHI Violations Detailed HIPAA Compliance program includes: Policies & Procedures Security awareness and training of workforce Records and information access Incident Response Hardware, Software & Transmission Security Detailed auditing procedures 11

10 Typical Field Technician Profile In depth medical record knowledge Excellent computer skills Familiarity with provider office Professional conduct at all times Knowledge of EMR systems RN s Nursing Assistant Nurse Technician LPN s Admissions Personnel Clinical Coding Specialist Coders Office Administration Medical Records Clerk Medical Billing Lab Assistant Social Workers Patient Service Clerk Clinical Care Coordinator Medical Administration 12

11 Methods of Retrieval On site o Paper Scan ECS will scan paper charts onto secure laptop o Print to Scan ECS Field Technician(s) come to the office, print charts from the EMR and scan onto secure laptop o Encrypted Flash Drive (IronKey) ECS retrieves charts from EMR with encrypted flash drive Off site o Fax/mail (usually for < 10 requests) o ECS can provide pre paid shipping labels o EMR Remote ECS can work with site s IT to remotely gain access to EMR and pull charts (most efficient method) 13

12 Scheduling Script 1 Call Provider Group If the provider contact is not responsive outreach will be made a minimum of 5 times, often daily attempts Ask to speak to the Primary and Secondary contact provided by PHC which were collected for your sites Explain this is a HEDIS Chart Review request on behalf of health plan(s) name,# of charts expected, and timeframes for retrieval. 2 Complete Site Contact Verification Verify contact first and last name, phone #, fax # (twice), address, and EMR system if applicable 3 Determine Best Retrieval Method and Schedule Dates Offsite Retrieval: EMR Remote. Last retrieval target date April 6, 2016 Onsite Retrieval: Remote EMR, CD/Flash Drive, or Paper Scan. Last retrieval target date May 1, Send Provider Prescheduling Packet Health plan letter Coversheet with confirmation of appointment date and contact information 14

13 Retrieval Process Overview: On Site Retrieval 15

14 Retrieval Process Overview: Off Site Retrieval 16

15 Provider Package Once ECS verifies your fax number and schedules a retrieval date(s), you will receive a provider package that contains: Cover sheet with: the office s contact info, ECS s contact info, method of retrieval chosen and retrieval instructions Partnership Health Plan s Provider letter Partnership s list of HEDIS documentation for ECS to retrieve by HEDIS measure Pull list containing member demographics and HEDIS measures to retrieve 17

16 Best Practices Anticipate ECS s call and plan on your preferred method of retrieval If ECS leaves a voic , return the agent s call or call the provider support hotline (877) (Provider Support) (817) (Provider Support Fax) Have your charts ready to expedite the retrieval If on site, designate a work station for the field technician If you do not have a chart that is being requested please indicate by marking the pull list C.N.A (Chart Not Available) 18 This will avoid further calls from ECS about this chart

17 Summary ECS is the contracted chart retrieval vendor for PHC ECS representative will contact you to schedule your sites beginning the week of February 23, 2016 Retrieval Methods Include: On site: Paper Scan, Print to Scan, Flash drive Off site: Fax/Mail, EMR Remote Have your charts ready to expedite the retrieval 19

18 HEDIS 2016 Timeline Primary Medical Record Retrieval & Review Annual Provider Info Form due Dec. 31 st Starting mid Feb ECS will call providers to schedule retrieval May 16 th Stop all retrieval and review Nov Jan February March April May June July August Nov. 23 rd ECS will Preschedule select sites for retrieval HEDIS Medical Record Kick Off Secondary Medical Record Collection Medical Record Review Validation Audit May 20 th 27 th June 16 th HEDIS Results locked in HEDIS 2016 Performance shared with Provider Network

19 Upcoming HEDIS Events HEDIS 2016 Refresher Webinar We will provide: Overview of HEDIS Changes for the HEDIS 2016 season Medical record retrieval process HEDIS 2016 timeline Key resources and contact information Date: February 2, 2016 Time: 12:00 1:00pm Registration:

20 Resources Visit our HEDIS Website HEDIS 2015 Performance What is HEDIS flyer HEDIS FAQs Upcoming Events and Activities Measure definitions and documentation requirements NCQA Website

21 Q & A CONTACT US: Phone (866) Fax (707) HEDISMRA@partnershiphp.org