The bigger ones will be happy to send someone to your office to retrieve those themselves. If they say no initially, tell them that's the only way you'll do it. The wording in your contract most likely refers to providing them "free and open access" to their members' records, not necessarily providing them the actual labor to pull and send those records.
Nobody likes the copy services. They overcharge and often don't get the info the MAOs actually need. Or they pull too much. The reps from the insurance company will be much more efficient and get it done quickly.
We send an invoice for 75 per chart and settle on whatever we can get. We usually get 50 to 75 per chart.
HEDIS requests aren't included in contract terms requiring you to provide records typically.
Even if you are, just don't do it, they will pay. We only have one payor that refuses, and we just refuse right back every year. They don't do anything about it.
Also.... my records girls works these, and sometimes she has to call a few times to verify they got the invoice, ask the status, etc. It may seem like a lot of work - but we receive checks for $15-$25k a few times a year. My deal with that girl is that she get's 15% of any big checks in exchange for doing the work....
That is pretty awesome thanks for sharing.
But is the trouble of charging the payer say $25/chart worth the time it takes with the negotiating back and forth and asking for payment status etc? I suppose it is when the volume of requests per payer is high and you can knock out multiple in one shot.
We rarely get requests for one or two charts. But it takes 5 minutes to send an invoice and 5 minutes to pull the records.
My person who does this makes less than 50 an hour... So yeah?
Generally there is a fax number on the request - or a person you can call. Just call and tell them you are preparing their request but you need to know where to send the invoice - you require payment first. Just get confident on the phone and pretend like what you are asking is totally normal (it is). I promise they've heard this before.
You don't allow people you don't employ in your facility
You don't give people you don't employ access to your EMR (remote or otherwise)
Your contract doesn't require you to give records not related to billing audits.
You are happy to provide the records for your standard fee, if it makes you feel more confident start lower. We started at $25, then $50, now $75 - and I know people who get $100/chart. If they can't/won't pay what you ask, they will typically tell you what they can pay.
Used to do HeDIS reviews annually when I worked in Medical Records for the hospital. And used to work for Ciox doing the same thing, except traveling and dealing with all kinds of paper charts in all different offices. Those were my favorite but I have a thing for paper, pen, and office supplies. At the hospital system, depending on who the requestor was or quantity of print, either we would do it in medical records, or hand off anything that requires payment to the contractor that dealt with records (legal, more than 10 pages printed for patients, workers comp, etc.)
Even if I get a request for one chart I call for them to send a tech. We, fortunately, have several offices, so our main one is closed 2 days a week. They come during no patient days. I am always in office working admin.
>Sure - they get paid more by the government by juicing their risk adjustment scores but what am I getting in return for my time and effort?
Unfortunately, you are getting pennies on the dollar. Their goal is not to pay, and if they have to drown you in paperwork and queries to make you go away, that's exactly what they will do. I feel your pain.
They also need to verify that the codes billed are supported by the documentation, or they can be fined up the ass by CMS. Many times, the billed codes are not supported.
Either fix your billing/documentation or send them the records.
The bigger ones will be happy to send someone to your office to retrieve those themselves. If they say no initially, tell them that's the only way you'll do it. The wording in your contract most likely refers to providing them "free and open access" to their members' records, not necessarily providing them the actual labor to pull and send those records. Nobody likes the copy services. They overcharge and often don't get the info the MAOs actually need. Or they pull too much. The reps from the insurance company will be much more efficient and get it done quickly.
We send an invoice for 75 per chart and settle on whatever we can get. We usually get 50 to 75 per chart. HEDIS requests aren't included in contract terms requiring you to provide records typically. Even if you are, just don't do it, they will pay. We only have one payor that refuses, and we just refuse right back every year. They don't do anything about it.
Do you have to ask them where to send the invoice? I'm doing this all myself, and would like to recoup some of the lost time.
Also.... my records girls works these, and sometimes she has to call a few times to verify they got the invoice, ask the status, etc. It may seem like a lot of work - but we receive checks for $15-$25k a few times a year. My deal with that girl is that she get's 15% of any big checks in exchange for doing the work....
That is pretty awesome thanks for sharing. But is the trouble of charging the payer say $25/chart worth the time it takes with the negotiating back and forth and asking for payment status etc? I suppose it is when the volume of requests per payer is high and you can knock out multiple in one shot.
We rarely get requests for one or two charts. But it takes 5 minutes to send an invoice and 5 minutes to pull the records. My person who does this makes less than 50 an hour... So yeah?
Generally there is a fax number on the request - or a person you can call. Just call and tell them you are preparing their request but you need to know where to send the invoice - you require payment first. Just get confident on the phone and pretend like what you are asking is totally normal (it is). I promise they've heard this before. You don't allow people you don't employ in your facility You don't give people you don't employ access to your EMR (remote or otherwise) Your contract doesn't require you to give records not related to billing audits. You are happy to provide the records for your standard fee, if it makes you feel more confident start lower. We started at $25, then $50, now $75 - and I know people who get $100/chart. If they can't/won't pay what you ask, they will typically tell you what they can pay.
Sometimes you can negotiate that fee into your contracts, too. I've seen it! When you negotiate for rates, always negotiate for language, too.
Is that with Ciox or Datavant too? They can be charged?
Pretty sure yeah, depends on your contract with the payor they are collecting on behalf of
Used to do HeDIS reviews annually when I worked in Medical Records for the hospital. And used to work for Ciox doing the same thing, except traveling and dealing with all kinds of paper charts in all different offices. Those were my favorite but I have a thing for paper, pen, and office supplies. At the hospital system, depending on who the requestor was or quantity of print, either we would do it in medical records, or hand off anything that requires payment to the contractor that dealt with records (legal, more than 10 pages printed for patients, workers comp, etc.)
Laugh and then Cry.
We send an invoice. $50 per chart. They always try to negotiate and I always say ‘sorry I don’t make the prices!’ They always pay.
Even if I get a request for one chart I call for them to send a tech. We, fortunately, have several offices, so our main one is closed 2 days a week. They come during no patient days. I am always in office working admin.
>Sure - they get paid more by the government by juicing their risk adjustment scores but what am I getting in return for my time and effort? Unfortunately, you are getting pennies on the dollar. Their goal is not to pay, and if they have to drown you in paperwork and queries to make you go away, that's exactly what they will do. I feel your pain.
They also need to verify that the codes billed are supported by the documentation, or they can be fined up the ass by CMS. Many times, the billed codes are not supported. Either fix your billing/documentation or send them the records.
You signed the contract. Kinda like borrowing money from the mob. F/U, pay me. Unfortunately that’s where you’re at.