Upload three years of data according to our specifications and qrcAnalytics will run your submitted Medicare member population through the qrcEngine™. The qrcAssessment™ quickly identifies your institution’s financial and quality opportunities, as well as any high-risk compliance issues by applying Centers for Medicare & Medicaid Services (CMS) and ICD-9/10 coding guidelines. qrcAnalytics has unique data mining capabilities and custom algorithms that take the mystery out of managing risk. Our qrcAssessment™ report identifies areas in need of improvement, including patient outreach opportunities, missing “recaptures” and much more. We provide you with high-level feedback and recommendations to support improved patient care and optimize appropriate reimbursements while supporting compliance.
- Patient Outreach Opportunities–Includes population management tools that enable healthcare organizations to better monitor patient visit activity, while supporting outreach goals to help ensure that every patient is seen each year
- Information on the following:
- Recapture Rate–a classification for monitoring hierarchical condition categories (HCCs) that were identified and captured during previous year(s), but not recaptured in subsequent year(s)
- Rate–% of the HCCs that were captured in previous years but are still outstanding during the current year
- Algorithm-based Missed Opportunities–unique revenue generating algorithms created by utilizing our clinical and coding expertise. By using this tool, we scan through labs, tests and some documentation to identify possible chronic conditions that have not been identified and submitted
- Algorithm-based Compliance Opportunities–unique algorithms supporting compliance created by our compliance experts, supporting clinical indicators, compliance triggers, and coding expertise within qrcAnalytics
- HCC Prevalence Rates–Centers for Medicare & Medicaid Services (CMS) and other sources identify certain conditions as prevalent among various populations and specific geographic areas. When your specific data is put through this tool we can compare the prevalence rates to your results, indicating an opportunity for clinical and coding education to better document, capture, and manage these conditions.
- Average Member HCC Score by Month–This tool is used to compare monthly HCC scores for your members. Use this tool to monitor for increases and decreases in the member’s risk adjustment factor (RAF) score. This tool can be used for outreach to clinicians who, in comparison, are not performing as well as their peers.
Once we process and present the qrcAssessment™ to you, we place the findings into the qrcReview™ tool where our hierarchical condition category (HCC) coders review it.
This is an preliminary, retrospective encounter level review with the purpose of verifying findings from the assessment and targeting clinical documentation subject areas to focus on for eventual correction.
STEPS TO PERFORM A qrcREVIEW™
- Supporting Documentation Review
We use our qrcAnalytics custom algorithms to create review cohorts. Then our coders review encounters in the customer electronic health record (EHR) system looking for supporting documentation in the clinical record for the review topic; we document all findings in the qrcReview™ tool.
- Quality Assurance Review
We display encounters that we capture in the Supporting Documentation Review pass in the Quality Assurance Review. Our secondary coder reviews the Supporting Documentation encounters in the customer EHR system and denotes whether to accept the conclusions of the original coder.
- Customer Acceptance Review
We display encounters that we confirm in the Quality Assurance Review pass in the Customer Acceptance Review. Our qrcAnalytics senior staff review each Quality Assurance Review confirmed encounter with you and document it in the Customer Acceptance Review.
- View qrcReview™ Summaries
Running totals for each review cohort (number of encounters, number of reviewed encounters, total RAF points found in documentation, total RAF points accepted by customer) can be viewed from the “Review” page.
We use the qrcAnalysis™ tool to document the findings from audits performed by HCC coders on clinical documentation stored in customer EHR systems.
This is a formal, diagnoses-level audit intended to ensure the correctness and completeness of clinical documentation.
STEPS TO PERFORM A qrcAnalysis™
- Analysis Diagnoses Associated with Encounters
Once we create an analysis cohort using our qrcAnalytics custom algorithms, our HCC coders analyze each diagnosis associated with a chart review set in the customer EHR system. Clinical documentation for each diagnosis associated with an encounter must stand on its own merits. HCC coders document each diagnosis via the qrcAnalysis™ tool. Coders can add missing diagnoses, request deletion of unsupported diagnoses, and confirm supported diagnoses.
- Clinician Communication and Corrections
HCC coders document all communication with clinicians pertaining to diagnoses “adds,” “deletes” and supporting documentation requests. Clinicians can agree or disagree with findings of the HCC coders. Clinician actions in the customer EHR system are documented in the qrcAnalysis™ tool.
- Final Outcomes
Final outcomes of “add” or “delete” diagnoses are documented in the qrcAnalysis™ tool.
After qrcAnalytics has completed a qrcAnalysis™, “add” and “delete” diagnoses corrections are summarized and re-submitted to source claim processing systems.
- Clinician Training Opportunities
After a qrcAnalysis™ has completed, we review clinical documentation error rates for each clinician for potential training opportunities.