So Many Records, So Little Time: How to Manage Burgeoning Health Plan Requests

June 15, 2023

Providers are witnessing an explosion in health plan requests for medical records. In some regions, request volumes are up by 30 percent over last year. Reasons for the spike include upticks in claims denials, more risk adjustment reviews, and increases in mandatory HEDIS reporting. No doubt these are topics that we’ll be discussing at the MRO booth (#213) at the upcoming HFMA conference.

Particularly for risk adjustment (RA) reviews, even the slightest gaps in reporting leaves health plans at risk for drops in quality ratings and subsequent revenue loss. And requests for patient data are predicted to intensify as health plans work to reduce per-member/per-month costs, earn higher STAR ratings, and meet the CMS 2030 value-based care goals.