HEDIS audit season is ramping up again. This means that you will probably be inundated with audit requests from all your contracted healthcare payors. HEDIS audits are an important check for gaps in care that can determine reimbursement rates, so you want to perform well. But the time and effort required to chase all the charts for these audits can be a real headache for already over-stretched staff whose priority is management of the complex issues of COVID-19.
Some “Solutions” Can Make the Headache Worse
Outsourcing audit chart retrieval can be an effective solution for over-taxed staff and providers. But you need to choose your audit partner carefully to avoid privacy and compliance pitfalls. Medical charts are protected health information (PHI) and their handling is regulated by a complex web of HIPAA and privacy laws and regulations. Some third-party aggregators who offer audit services use untrained and uncertified staff to perform chart retrieval and review services, which exposes both payors and providers to risk.
HEDIS Audit Support Checklist
As you evaluate your options for outsourced audit support, use this checklist to ensure that you get the support you need without exposing your organization to risk:
- Does the outsourcing partner have expertise in HIPAA and/or privacy law?
- How much experience does the outsourcing partner have with HEDIS audits?
- Are the outsourcing partner’s staff certified release of information specialists (CRIS)?
- Does the outsourcing partner have existing relationships with your organization or your payor’s organizations?
- How familiar are the outsourcing partner’s staff with the leading EMR systems?
- Is the outsourcing partner able to flexibly assign HEDIS specialists as needed to ensure rapid execution to respond to audit deadlines?
- Importantly this year, can the outsourcing partner perform their work remotely, through HIPAA-compliant transmissions?
Sharecare HEDIS Audit Support Specialists Take the Headache Away
We have a flexible team of HEDIS audit retrieval specialists who are CRIS certified, understand requirements and can meet demanding deadlines. Our expertise in HIPAA and privacy law, familiarity with multiple EMR systems and our track record of on-time execution offer you a proven solution for your HEDIS audit retrieval needs. We offer remote services through secure, HIPAA compliant transmissions. You can rest easy knowing you are in compliance, and your patients’ PHI is being handled by the team with the best ROI quality assurance record in the industry.
A track record of successfully delivered HEDIS audit results can lead to higher reimbursement rates and bonuses for your organization. Sharecare can take the headache out of the process by delivering the right charts, on time, and in compliance with all HIPAA and privacy laws, so your organization can focus on what you do best: patient care.