Commercial Risk Adjustment (CRA) reporting update: Retrospective Program begins; benefits of direct connection access to your EMR

Continuing our 2019 CRA updates, we request your assistance with respect to our CRA reporting processes. As a reminder, there are two approaches that we take (Retrospective and Prospective) to improve risk adjustment reporting accuracy.  This month we’d like to focus on the Retrospective approach, and the request to our providers.

Retrospective Program:

• Focus is on medical chart collection
• Medical record documentation supports provisions of ACA that require Anthem to collect and report diagnosis code data for ACA members
• Medical chart collection will start soon (separated in three different time periods)
  • Period 1 (June 2019)
  • Period 2 (November 2019)
  • Period 3 (January 2020)

 

Anthem’s medical chart collection is in compliance with the ACA provision to collect and report diagnosis code data for ACA members

 

Electronic options for chart collections:

Submitting medical charts to payers can be extremely burdensome and time consuming for your staff.  Utilizing an electronic option can alleviate the constraints on both staff resources and time.

 

• Remote/Direct Anthem Access
  • The most efficient option is to allow Anthem’s medical coder team to have direct connection access to your EMR system for Anthem to retrieve member records.
  • Allows for no vendor interventions and fewer handoffs of the records.

 

To address compliance concerns, please note that as a health plan, Anthem is a covered entity under the HIPAA Privacy Rule and is bound to protect PHI.

 

Benefits of providing EMR direct connection access

• Medical records staff resources minimally contacted for charts requested
  • Depending on EMR system, requests may also be handled electronically through “push” notifications
• Medical records staff will release only those records requested into EMR queue for which we have access
• Cost savings - - less administrative impact on staff and no paper copying costs
• Better privacy/security measures - - no need to save medical record to desktop and then copy/save before transmittal

 

• EMR Interoperability. Options are in place for the following EMR systems:
  • Allscripts (Opt in –signature required. Need to work directly with the CRA representative for your region)
  • NextGen (Opt out – auto-enrolled)
  • Athenahealth (Opt out – auto enrolled)
  • MEDENT (Opt in – signature required. Need to work directly with the CRA representative for your region)

 

• Inovalon virtual visit or onsite
  • Inovalon will work directly with your office to utilize electronic connectivity for a virtual visit, or they will have their staff go into the office for medical record retrieval based on a scheduled time that is convenient.

 

• Secure FTP
  • Set up directly with our vendors as a temporary secure FTP to transfer medical records. 

 

If you are interested in any of these electronic options, or would like to grant our Anthem medical coders with direct access to your EMR, please contact our CRA Representative Alicia.Estrada@anthem.com.

 

Thank you for your continued efforts with our CRA Program, and expediting these medical chart collection requests that will begin soon.