Health Information Technologies and Processes

Record Retrieval for HEDIS Purposes

  • 1.  Record Retrieval for HEDIS Purposes

    Posted 04-12-2019 07:45
    For HIM Professionals that work in the locations that receive health insurance requests for medical record information associated with HEDIS measures, do any of you have some best practices you can share specific to how your organization processes these requests?

    Thank you.  

    Chris Ordonia, MPH, RHIA, CPHQ

  • 2.  RE: Record Retrieval for HEDIS Purposes

    Posted 04-12-2019 18:26
    I would also be really interested in people's experiences with this.

    Jacqueline Mccauley
    Him Director

  • 3.  RE: Record Retrieval for HEDIS Purposes

    Posted 04-12-2019 19:41
    I'm interested, too.

    Katherine Valeri, RHIT
    Medical Records Consultant
    KV Health Information Management Consulting

  • 4.  RE: Record Retrieval for HEDIS Purposes

    Posted 04-13-2019 05:32
    depending on the number of charts requested and who's requesting, I recommend to my facilities that they call and set up a date and time for the requesting entity to visit and copy want they need. I have found with many of these we are sending thousands of pages and half of the information is not needed. It's been my experience it's easier on my staff. Of course, one needs to be with them and help and this isn't always possible so I will step in. I have to review the request and approve anyway. Hopefully that helps

    Anissa McBreen RHIT
    McBreen Consulting
    HIM LTC Consultant

  • 5.  RE: Record Retrieval for HEDIS Purposes

    Posted 04-15-2019 08:59
    Due to the volume of requests, our organization gives remote security access to our E H R. The volume of requests by patient and number of visits that would require medical record "copies" is too large to handle. Another option is to solicit the help of an ROI vendor.

    Natalie Novak, MHSA, MBA, RHIA
    Executive Director Corporate HIM Division
    Franciscan Alliance

  • 6.  RE: Record Retrieval for HEDIS Purposes

    Posted 04-15-2019 10:13
    ​We do a similar process.  When possible, we do set the auditor up with EMR access and create a patient list for them to review.  We also make them work around our schedule for when to come onsite and do the review.  We tell them available dates and they have to work around that.  We make them all come at once.

    Seth Katz
    Associate Chief Information Officer
    Truman Medical Center

  • 7.  RE: Record Retrieval for HEDIS Purposes

    Posted 04-15-2019 10:22

    We process all the requests and it is quite time consuming.  I have 1 FTE that supports this work and other government audits.



    Becky Kilen, MS, RHIA

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  • 8.  RE: Record Retrieval for HEDIS Purposes

    Posted 04-16-2019 11:34

    Ours varies.  Via SFTP, paper, or remote access to our EHR. 


    Leah Beck, RHIA


    Health Information Management

    Phone: 909.580.0099


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  • 9.  RE: Record Retrieval for HEDIS Purposes

    Posted 04-16-2019 10:12
    We have a combination of all of these.
    If the request is limited to a few patients (under 10), an in-house HIM tech processes the request.
    If the request is larger than 10 patients we will do remote access for the auditor or schedule an in person retrieval. For in person retrievals an account is created for the auditor and an in-house HIM tech orients them to our system. After orientation they are left to work at their pace and ask questions if needed. Once they leave, their credentials are removed from the system. If the auditor opts for remote access we create a remote access with a limited amount of time. They can reach out if more time is needed. At the conclusion of either of these we receive the updated list of patients (electronically) that info was pulled from so we can speak to the retrieval in detail if needed. I maintain those list electronically.

    Sabrina Brasuell
    Health Information and Compliance Manager
    Community Health Alliance Reno, NV

  • 10.  RE: Record Retrieval for HEDIS Purposes

    Posted 05-10-2019 15:12
    Having worked with all of the suggestions below, my recommendation for the HIM is to outsource this piece, even if you keep the regular ROI in house, the audits for HEDIS and MRA are just going to grow so this may be a good option. These are typically revenue depleting requests to the HIM dept albeit cost neutral or beneficial to the organization in the long run.  The benefit can still be recognized by the HEDIS scores while not having the medical record department take the time and labor needed to process these requests. The training that is received on required documents per measure is pretty incredible in the ROI vendor world too.

    Traci Overway
    Regional Vice President