Ways to Simplify Chart Chasing

Chasing charts has become a necessary evil in healthcare. As patient visits to healthcare facilities increase and the number of medical records rise, it is often up to administrative staff to take on the task of tracking down missing or incomplete documents. This can be an incredibly time-consuming process, but it is necessary for ensuring accurate diagnoses and effective treatments.

Fortunately, there are ways to simplify chart chasing in order to streamline the process and reduce delays. By leveraging technology, automating manual processes, and implementing organizational best practices, healthcare providers can ensure they have access to all the information they need when they need it. With these strategies in place, chart chasing can become less of a hassle and more of a streamlined system that helps keep patients safe.

What is Chart Chasing Exactly?

"Chart chasing" is an all-encompassing phrase for the different tactics utilized by commercial and Medicare Advantage (MA) plans to get access to healthcare providers' records.

When it comes to chart chasing, the way in which providers are associated with a plan can lead to drastically different logistics. For instance, if all of an HMO's panel members are using the same health information technology systems for capturing and storing medical records, then direct electronic access is attainable. This is especially true regarding closed-panel HMOs.

Compared to other healthcare plans, such as Preferred Provider Organizations (PPOs), direct electronic medical record access is less likely. Usually a request must be sent from the plan to the provider through an electronic message like email or web interface and may even need fax confirmation. Phone calls can also prove useful in verifying how the request should be processed or for updates on its status.

To successfully capture the necessary data elements, like supporting evidence for a diagnosis code, from paper and electronic records, one can either hire an external vendor or use technology to digitize charts. With advanced software that identifies distinct data elements quickly and accurately, organizations can significantly improve their efficiency while collecting essential information.

Advanced technology, featuring artificial intelligence in healthcare like machine learning and natural language processing, is often used to convert unstructured text data into a more accessible format. This allows us to link different records of the same enrollee as well as connect them with medical billing/encounter information. With these improvements in place it becomes easier to accurately track patient history while providing an effective bottom line for any organization or practice.

What Factors Fuel Chart Chasing?

From time to time, it is necessary for a plan to correct the risk score accuracy of its enrollees by requesting medical records from providers and properly document diagnoses that support their HCC scores. For instance, if an enrollee has been diagnosed with a chronic condition and this diagnosis hasn't been reported in the current year yet, chart chasing becomes essential for ensuring accurate HCC coding and scoring.

To further promote accuracy and efficiency, some plans use predictive modeling to detect potential conditions even if they have not been documented in previous years. This can be based on an individual's age, gender, drug usage history, lab results or past medical processes — all of which provide a higher probability that certain conditions may exist.

A certain level of record-keeping may be necessary to validate the services provided during a medical visit were covered by the enrollee’s benefit design. But in such circumstances, providers are more likely to give charts and other information needed for reimbursement of eligible services.

When Does Chart Chasing Take Place?

When chart chasing, plans will typically look at past data to identify members with a greater probability of having medical conditions that have not been reflected in the current year's medical records. Additionally, they may search for cases where either specific health issues are listed on billing and encounter forms yet absent from evidence found within actual patients' charts (or vice versa). Utilizing the list of potential conditions without proper documentation, health plans can analyze all medical records pertaining to the enrollee and reach out to relevant professionals for appropriate remedial steps.

Furthermore, due to the timely nature of this intervention, care management teams have access to reliable clinical data that is important for patient health at the most critical times.

By deploying tools within the EHR systems, providers can be supplied with pertinent details during patient encounters to ensure accurate coding. This could include a list of previously noted chronic conditions associated with the patient or relevant lab tests, medications and services they have received. This would be invaluable during yearly wellness exams.

Challenges With Chart Chasing

Plans struggle when it comes to keeping track of consistent and complete data, for example due to inconsistencies between the contact info provided by medical practitioners and the physical location of their records. This can be caused by a number of different issues; for instance, providers often use multiple service locations that don't all possess access to necessary documents. As such, plans without direct enrollee record access usually have difficulty retrieving this information.

In addition, provider education on necessary documentation is also a problem. Even if providers have the pertinent paperwork, it must adhere to payment criteria for it to be accepted. To illustrate this point further, when seeking an HCC reimbursement from insurance companies, clinical information in the patient's record should indicate the presence of said condition and plans made for its treatment by qualified healthcare personnel.

From coding transposition errors that lead to the wrong diagnosis being submitted on a claim, to completely incorrect records, documentation mistakes can be time-consuming and resource intensive. When incomplete or faulty information is found it requires additional effort in order to acquire more data or fixing any inaccuracies - both scenarios can add up quickly if done at scale.

Certain states have taken steps to guarantee patients' right to privacy, like mandating that authorization is needed for mental health-related information. This impedes the acquisition of medical documentation relating to relevant conditions. On top of this, insurance firms grapple with collecting records from specialists they don't have a contractual agreement with when it comes to out-of-network referrals.

Furthermore, chart chasing necessitates a significant amount of labor and transaction costs for the direct retrieval activity alone. That is without mentioning the substantial indirect expenses associated with adjusting to continually evolving provider processes and vendor connections.

Fortunately, cutting-edge solutions exist that permit data access and retrieval; plus, as more organizations embrace standards and interoperability measures, these services will only become even more effective.

Recommendations to Improve Chart Chasing

When you need to conduct extensive historical record reviews, it is critical that your effort and resources are strategically targeted. Strategies such as targeting highest risk diagnoses, or likely underreported conditions can be used to get optimal results while minimizing exposure to common issues.

Additionally, healthcare analytics can help plans pinpoint providers who are likely underreporting so they can engage them in more specific training. Not only will this boost the return on investment and reduce provider abrasion but it will also increase the efficiency of the entire process.

Providers that are equipped with software powered by artificial intelligence, such as natural language processing and machine learning technologies, paired with access to EHRs, it is likely that concurrent coding can be achieved on a prospective basis. By structuring workflows in a concurrent setting, automated coding through EHR submissions can take place almost instantly. This guarantees that coded information is accurately reflected within the claims, eliminating unnecessary retrospective chart reviews and relieving providers of any associated burden with retrieving charts.

Moreover, plans should strive to incorporate all possible coding capabilities. Supporting providers with computer-assisted coding tools can help lessen mistakes and workload on providers during both initial coding and potential extra chart pulls for any reviews in the future. Such alerts could even be beneficial when creating proactive requests from out-of-network healthcare professionals regarding required medical record documentation in the referral process.

Final Thoughts

The conclusion is that healthcare organizations can work towards improving their chart chasing processes by incorporating various strategies and solutions, such as targeting high risk diagnoses, embracing automated coding tools with artificial intelligence, and involving providers in training programs. These measures will allow them to reduce costs while also improving patient care through better medical records accuracy. Ultimately, this will help reduce the need for chart chasing and if required allow for a more efficient chart chasing process which will benefit both patients and health plans alike.

You work hard to offer medical services to complex populations. Eliminate chart chasing by capturing every appropriate HCC code at the point of care with risk adjustment coding software from ForeSee Medical.

Blog by: The ForeSee Medical Team