HEDIS® Medical Record Validation

Starting with HEDIS® 2015, the audit rules are expected to become more stringent and less forgiving than in the past, specifically around Medical Records Review Validation (MRRV or MRV). The expected net impact for most plans is that the timeframe for the hybrid portion of the project, medical records collection and abstraction, will be compressed by at least two weeks.

HDVI has developed guidelines for both HEDIS® Hybrid Project (also called Medical Record Review) Timelines and a Best Practices Checklist which every plan should consider using.

In addition, HDVI is significantly enhancing already existing features to support audit preparation and response tools. These features will not only eliminate a significant amount of manual work, they will allow client users to focus specific attention on samples and measures that are subject to audits, automatically generate outputs for the auditors, and include supporting documentation.

New and enhanced features for MRCS 4.0 (for HEDIS® 2015) relevant to MRV include:

  • Configurable client (secondary) overread incorporated in workflow
  • Convenience Sample Audit Prep Feature
  • MRV Audit Prep Review Features
    • for specified measures/measure groups
    • for exclusions
  • Enhanced overread tracking and reporting (real-time)
  • Admin data refreshes (compliant with NCQA rules)
  • Measure, Submeasure, Measure Group views
  • and more...

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