Three Strategies for Managing HIM Demands During Payer Audits and Reviews
MRO’s Greg Ford, Senior Director of Requester Relations and Receivables Administration, offers practice guidance and strategies to HIM departments trying to cope with rising demands for the disclosure of PHI during payer audits and reviews.
In recent years, healthcare organizations have experienced a steady increase in DRG/post-payment audits and Health Effectiveness Data and Information Set (HEDIS)/risk adjustment reviews. According to MRO statistics from 2017 to 2018, overall payer requests increased 70 percent due to a significant upsurge in core categories—DRG audits up 52 percent, HEDIS reviews up 62 percent, and risk adjustment reviews up 80 percent.
This rising volume of requests from payers heightens the burden on HIM to handle the associated release of information (ROI) demands. To better control the surge in payer requests, HIM departments should consider the following three strategies:
- Manage time frames
- Refine language in managed care agreements
- Promote education, communication, and collaboration regarding record access
This article explores each of these strategies and provides practice guidance to HIM departments trying to cope with rising demands for the disclosure of patient information during payer audits and reviews.