Medical Record Abstraction

Ensure thorough documentation of compliant care to improve quality scores

For health plans and other healthcare organizations, the quality measurement and reporting process grows more complex and important every year. Measuring and reporting quickly, efficiently, accurately, and thoroughly are essential.

Cotiviti Medical Record Abstraction services deliver rapid, accurate abstraction of clinical data components that document the provision of compliant care. Our goal is to achieve the highest number of compliant components possible within any reporting time frame, optimizing health plan quality scores and revenue, as well as helping to close care gaps.

The Benefits

Accuracy

Focus, rigorous training, and continuous QA ensure consistent performance at better than 95 percent accuracy rates throughout the season.

Scalability

We can readily staff to meet your needs, no matter how great the volume.

Transparency

Our experts are just a phone call away for any question or clarification.

Staffing for success

Each client’s project begins with a careful assessment of scope. We review prior-year benchmarks for forecasting purposes, look at the anticipated volume by measure, then determine the number and proper mix of staff to ensure that the project will be completed on time and with the highest level of accuracy.

We use a combination of internal staff, direct contract staff, and vendor staffing partners to form a bank of expert registered nurses and certified coders. This approach allows us to handle volume spikes with ease. Registered nurses have clinical and chart review experience, and coders are certified through AAPC or AHIMA.

Our staff can extract information directly from electronic medical record (EMR) systems, which saves time and increases the number of compliant hits. We can also highlight the record, helping clients and auditors to quickly find the same information.

For organizations looking to reduce costs—25 percent cost reductions are typical—we also have an offshore option. Nurses are registered in the United States, and all overreading and quality assurance (QA) is performed on shore.

 

Rigorous training and QA

We conduct thorough NCQA technical specification training for our teams, focusing on measures that match their areas of clinical expertise. At the end of training, each team member is tested by abstracting a set of mock records. Each team member must achieve 95 percent accuracy to pass in no more than four tries. We also perform inter-rater reliability (IRR) testing, which must be passed with 100 percent accuracy in no more than three tries.

On the job, 100 percent of an abstractor’s work is overread until his/her ability to maintain the 95 percent accuracy level is proven. Overreading then drops to 50 percent; if quality remains at 95 percent, overreading is then maintained at 15 percent. If at any point an abstractor’s quality begins to dip, we retrain them and start the process over again. Overreaders are subjected to the same close scrutiny.

 

Accurate and efficient workflow

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1 Random batch of overread records are selected for quality assurance by our most experienced abstractors. More accurate abstractors have smaller overread batches
2 Random batch of overread records are selected for quality assurance by our most experienced abstractors
HEDIS* is a registered trademark of the National Committee for Quality Assurance (NCQA).

Industry-leading communication and transparency

We understand that you will have questions, and we go out of our way to help. We reach out to NCQA for clarification on your behalf, so you are always getting firm, fast, direct answers.

Our regular reports include:

  • Project status with retrieval, abstraction, and quality reporting
  • Weekly and cumulative quality scores, including identified errors and how errors can be corrected
  • A dashboard of non-compliant chase reason codes illustrating what’s missing in the record or where records need to be pursued elsewhere

We also develop a road map and client handbook—tools that help our staff and our clients understand our approach.