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March – April 2019
A message from Dr. S. George Kipa
Reducing the need for medical record reviews
One of the main complaints I hear from physicians when I meet with them involves requests for medical record reviews. These reviews are very time-consuming, both for Blue Cross Blue Shield of Michigan and for the health care providers who receive these requests.
To help address these concerns, we put together an article for the February Record that explains what you and your staff need to know about medical record reviews. One of the purposes of the article was to provide information that can help reduce the need for medical record reviews and the work associated with them.
In other matters concerning medical record reviews, I wanted to let you know that this is the time of year when we’re conducting HEDIS® medical record reviews for randomly selected members. These reviews, which kicked off in February and continue through May 2019, are conducted to help ensure that HEDIS quality measures are being met for members.
As part of these reviews, we’re looking for details that may not have been captured in claims data, such as blood pressure readings, HbA1c lab results, colorectal screenings and body mass index. For more details, click here.
In the March Record, we provided additional information and tips on how to improve HEDIS scores and reduce medical record reviews through correct claims coding. The article addresses how CPT Category II codes and Z codes can be used to give you credit for quality care without the need for medical record reviews.
We’re also reminding physicians to discuss fall risks, urinary incontinence and physical activity with their Medicare-eligible patients. We’ll be surveying select Medicare Advantage members from April through July 2019 related to these topics, which are reflected in three key HEDIS measures:
- Fall risk management
- Management of urinary incontinence in older adults
- Physical activity in older adults
To learn more, see the article in the March Record.
I hope this information can help you reduce the number of requests you receive for medical record reviews, improve health care quality and HEDIS scores, and streamline the process of submitting medical records for review. I encourage you to share this information with your staff. If you have any questions or concerns, email me at GKipa@bcbsm.com.
S. George Kipa, M.D., is Blue Cross Blue Shield of Michigan’s deputy chief medical officer.
*HEDIS, which stands for Healthcare Effectiveness Data and Information Set, is a registered trademark of the National Committee for Quality Assurance, or NCQA.
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