Should your medical record collection efforts be completed by an in-house team or outsourced to a vendor? Let’s first examine the importance of efficient medical record collection and how it enables you to submit complete, accurate, and timely data for risk adjustment audits and quality measurements. The sooner you collect records, the longer you have to assess them for completeness and to review the accuracy of their abstraction.
“Inconsistencies and incomplete entry in the medical record can affect the data that is abstracted during retrospective analyses,” states a Columbia University guide for creating a retrospective review form. So, you must collect all of the necessary medical records and ensure that they are complete.
But you should also know which records to collect, what they should include, and the best way to retrieve them so that you can reduce provider abrasion. Overloading providers could frustrate them and prolong your medical record retrieval (MRR) process.
An efficient medical record collection strategy can help you submit complete, accurate, and timely data while reducing provider abrasion. Improving the operational efficiencies for medical record reviews will also reduce risk and preserve revenue integrity.
You can keep your medical record collection team and processes in-house or outsource your medical record collection to a vendor. Here are pros and cons for each approach:
In-House Medical Record Collection
Pros
More access: Communicating with and managing your medical record team is often easier when its members are in-house. You can sometimes solve problems with a walk down the hall instead of waiting for a callback.
Greater control: Employees may also be more responsive, because they are directly accountable to you. You can manage their time and efforts more precisely than if you were to cede control to a vendor. Employees may also be more loyal to your organization than an outsourced professional would.
Resources: You have already invested in your in-house team in terms of its compensation, the resources that you have provided to it, and the processes you have developed. You would incur additional costs if you were to outsource medical record collection, thereby reducing the return on your current investment. Each health plan will be unique in terms of the resources it has on staff.
Cons
People-intensive: Investing in an in-house team is a considerable expense. For example, you must staff for medical record collection, abstraction, data management, and project management. If you are unable to staff appropriately, you may not only be sacrificing the collection of medical records but also forgoing time available to focus on rate-improvement activities.
Time-consuming: The Healthcare Effectiveness Data and Information Set (HEDIS) becomes an all-consuming activity for your quality department, fully occupying the people you’ve assigned to it early on and drawing in every available resource by the end. With anyone and everyone making outreach calls to members and providers, your organization may do little except retrieve medical records as the deadline nears.
Outdated methods: Optimizing medical record collection isn’t your organization’s primary mission. Thus, you may not have the most advanced technology or be aware of the best practices. You risk frustrating providers if you do not have systems to support your staff requesting medical records by asking for the same record multiple times from different people.
Relying on traditional methods like in-person collection and faxes could slow and complicate MRR and its associated personal health information (PHI) management, potentially jeopardizing compliance with deadlines and regulations as a result.
Vendor medical record collection
Pros
Advanced and up-to-date technology: As specialists in MRR, vendors can provide medical record workflow automation software that helps you manage all chart coding efforts within one platform in an end-to-end integrated process. This allows you to leverage your in-house team for rate-monitoring and -improvement activities.
Latest tools: Established systems also tend to be better for capturing and analyzing data than homegrown systems. They can secure PHI and improve medical records auditability as well. Seeking to replicate proven products internally could be costly and perhaps undoable, given their advanced evolution.
Proven expertise: Your vendor should also bring awareness of, and experience in, best practices for medical record retrieval. Your vendor knows how to optimize your workflow and collaborate with providers, because it has perfected the process for numerous health plans. It can also help you implement rate-improvement activities and complete HEDIS audits more efficiently. An in-house team can be considerably more costly when it comes to hiring the breadth of expertise that a vendor can bring to the table and the number of staff required to execute the project.
Performance guarantees: By utilizing a vendor, you may be able to negotiate lower fees if your vendor fails to hit agreed-upon benchmarks, like for the percentage of assigned charts that it collects and quality abstraction. Vendors also have incentive to perform well, as they know they are at risk of being replaced more quickly than a health plan would replace its own staff.
Cons
Flexibility: Often, vendors are providing services for more than one client. As a result, they may not be able to make changes to their system specific to your organization’s needs, as it might not be applicable or useful to other clients using their systems. Working with your vendor early to identify ways to work together and understanding requirements that your organization has and what the vendor can do to meet them can help address issues early on and reduce the need to change systems or processes midstream.
Lack of organizational support: Your bosses may not perceive a need for or value in the outsourcing of medical record collection and review, particularly if they feel that your in-house team and processes are adequate. Convincing them of the efficiencies that your organization could gain, as well as the revenue that you could preserve, could be difficult if not impossible. Knowing your goals, your baseline performance, and associated costs compared to vendors’ experience is key in making a realistic proposal.
An optimized end-to-end MRR process can deliver a major contribution to the efficiency and, ultimately, profitability of your organization. Consider the pros and cons above when choosing whether in-house or vendor medical record collection is right for your organization.
