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In a HFMA blog, MRO’s Greg Ford, Director of Requester Relations and Receivables Administration, offers insight and tips on how to prepare for HEDIS Reviews.

Health plans and government payers conduct Healthcare Effectiveness Data and Information Set (HEDIS) reviews annually from January to mid-May, and the process typically is in full swing by March. More than 90 percent of all insurance companies participate in HEDIS to improve their Star ratings (as set forth for the Centers for Medicare & Medicaid Services) and quality scores. In fact, our experience in filling medical record requests for HEDIS and other payer reviews in 2017 demonstrates a significant increase in review volumes, especially as payers improve efforts to implement the HEDIS process.

As the volume of reviews climbs, providers incur additional staff burdens and increased operational costs. However, HEDIS also benefits providers. Providers gain the ability to view the effectiveness and quality of each health plan, which increases provider leverage during contract negotiations. Plans that perform well can command higher rates.

Greg Ford

Greg Ford

In his role at MRO, Ford serves as a liaison between MRO’s healthcare provider clients and payers requesting large volumes of medical records for purposes of post-payment audits, as well as HEDIS and risk adjustment reviews. He oversees payer audit and review projects end-to-end, from educating and supporting clients on proper billing practices and procedural obligations, to streamlining processes that ensure timely delivery of medical documentation to the requesting payers.

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