5 challenges of chart chasing
By Eric Hedrick
Are you spending too many resources chasing charts? The answer is probably yes. Validating diagnoses for members is critical to success for any risk adjusted population, and retrieving and coding charts is the most popular process used to tackle this issue.
While chart chasing can be helpful, there are inefficiencies that can be a burden. Here we’ll discuss what they are.
What is chart chasing?
Chart chasing is the process that commercial, Medicaid, and Medicare Advantage plans undergo to gather medical records from various sources and validate diagnoses. The goal: Ensure diagnoses are appropriate and to the highest specificity for the member.
What are the challenges?
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The provider burden is high.
Medical record collection isn’t simply a one-and-done process for providers. They’re dealing with multiple payers seeking the same medical information. This process can be redundant for providers, leading to increased time spent on their end.
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There’s duplicate demand.
Chart requests often coincide with the end of Centers for Medicare & Medicaid Services submission windows, which means not only are they dealing with multiple payers, but they’re dealing with them all at the same time.
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Payers consistently work with incomplete data.
Reviewing medical records gives payers the most accurate picture of a member’s health. Unfortunately, chart retrieval and coding projects are concentrated after a year is complete. This delay inhibits any clinical benefit that could occur from knowing this information closer to real-time.
For example, not having an accurate picture of a patient’s health until the end of a submission timeframe can lead to patients missing out on care management services. It also wastes resources on in-home assessments for gaps that have already been closed.
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It can be costly and wasteful.
While an individual chart retrieval and review isn’t expensive, the cumulative expense for health plans can be substantial, particularly for Medicare Advantage plans. And it’s not just the expense, but the inefficient use of healthcare resources including coders and doctors.
Why? Coders, who are responsible for reviewing the charts, often experience a high volume of work at the end of the year while being underutilized during the year. And the process of sending physical resources to offices, driving for hours, and sorting charts by mailrooms only adds to the administrative costs. These are all avoidable expenses, but they persist, leading to money spent that doesn’t have a clear benefit to healthcare outcomes.
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There are industry-wide inefficiencies.
In our experience, up to 90% of encounters reviewed will provide no incremental benefit in terms of closing gaps. While some of this work is still valuable to validate accurate claim diagnoses, a considerable portion of it is a waste of resources.
This inefficiency is further exacerbated because the same companies identifying targets for medical record review are also selling retrieval and coding services. This creates a conflict of interest in which better targeting, which would result in fewer charts, reduces the vendor’s revenue streams.
While chart chasing might be a behind-the-scenes challenge, it affects the way we receive healthcare. By understanding the process, we can work to make it more efficient.