The HEDIS® 2013 project season is coming to an end and Medical Records Review Validation is more stringent than ever, with tighter timelines leading up to it. Uncertainty remains until the auditors give an 'all clear' in the next couple weeks. Not fun.

So, what have we at HDVI done this year to assist clients with their HEDIS® Hybrid projects? Well, quite a few things, including even more stringent quality controls on abstraction, over-read and data. The latest features we rolled out just ahead of the MRRV weeks may deserve special attention because they aim to make MRRV as pain-free and anxiety-free as possible.

What we came up with are two wizards. This blog post discusses the first one. The second one will be discussed in our next blog post.

The MRRV Preparation Wizard

It is common, logical and prudent to review all the MRs and abstractions for the numerators chosen by the auditor (typically 5 numerators and all exclusions). In addition to all the QA features and over-read capabilities (for project team and/or client), the wizard allows the selection of the relevant numerators. It provides a simple yet powerful way for a targeted review of all the hybrid-positive numerators and the associated medical records, and tracks 'cleared' members and those with issues/questions/concerns.

Results: HDVI's project teams reviewed the relevant numerators in a 'beta-pass' in just a couple hours, then clients performed their own review using the wizard. Within a couple days, any members with questions were isolated and resolved (no abstraction errors were found due to prior QA working as designed). Last-minute abstractions that came in were easily identified and reviewed as well. Member lists for the relevant numerators and exclusions were created with the click of a button. Now we wait…

Return for part 2, where we discuss how the second wizard makes completing the MRRV Sample process easy.

About The Author

Reveleer is a healthcare-focused, technology-driven workflow, data, and analytics company that uses natural language processing (NLP) and artificial intelligence (AI) to empower health plans and risk-bearing providers with control over their Quality Improvement, Risk Adjustment, and Member Management programs. With one transformative solution, the Reveleer platform allows plans to independently execute and manage every aspect of enrollment, provider outreach, data retrieval, coding, abstraction, reporting, and submissions. Leveraging proprietary technology, robust data sets, and subject matter expertise, Reveleer provides complete record retrieval and review services, so health plans can confidently plan and execute programs that deliver more value and improved outcomes. To learn more about Reveleer, please visit Reveleer.com.