Chart Reviews In The Age Of EHRs
By Linda M. Girgis, MD, FAAFP
Anyone who contracts with health insurance companies knows chart reviews are part of the process with an insurance company chart reviewer coming to the practice every so many months to review practice charts and collect data. I suspect it is to make sure we are staying compliant with their billing requirements.
Before the dawn of EHR technology, a pile of paper charts was left on a desk for the reviewer to inspect and analyze. He or she would copy whatever data they deemed necessary and be on their way and we often forgot they were even there. But, chart reviews in the age of EHRs can be disruptive.
Recently, a reviewer came to my practice a week before her scheduled time. My billing clerk opened the electronic records for her and pointed out areas of the chart she may need. Unfortunately, in the barrage of EHRs hitting the market, they are not all the same and she had never worked with our system before. While my billing clerk attempted to do the job that I was paying her for, namely billing, the reviewer assailed her with a myriad of questions on how to use the system. For the next hour my employee helped the reviewer navigate the system — I was basically paying her to baby sit an insurance company employee while neglecting her own job.
I wasn’t eaves dropping but I did overhear much of the discussion between the two. The reviewer seemed somewhat distressed I did not document that I distributed patient education materials to my patients. My biller came to ask me about this situation and I explained that I like to educate my patients by giving them websites to visit so they can explore more on their own.
Seemingly, this answer did not satisfy the reviewer but she pretended it was a good alternative. However, it was obvious she did not know what to do with this fact. I would think that, since we entered the 21st century more than 15 years ago, going digital would seem more efficient to most people. Wasn’t one of the main goals of implementing EHRs to go paperless? Yet some insurance companies are still grading us on whether we hand out pieces of paper to patients.
When leaving, the reviewer told my biller she would calculate our points and we would get a report back. I think I passed because as she was passing by me, she told me my charts were excellent. Our practice qualified for the first two stages of MU, PQRS, and the PCMH based on our metrics. Apparently, though, certain managed care HMOs require different metrics. She left us with information regarding HEDIS and ICD-10 and I now know my patients were safe.
The whole chart review process has become quite disruptive with the implementation of EHRs. My staff often needs to devote time to help those performing reviews navigate the system. In a small private practice, there is no time for them to do this and there is no benefit to us. In fact, if they don’t like our charts, the process may be harmful.
EHRs are definitely a vast improvement over paper charts of the past, but there is still a long way to go. If someone from an insurance company wants to do a chart audit, fine by me — after all, it’s in my contract. But, stop hijacking my staff. We need a better way.
About The Author
Linda Girgis, MD, FAAFP, is a board certified family doctor with Girgis Family Practice. Dr. Girgis studied medicine at St. George’s University School of Medicine and served her residency at Sacred Heart Hospital in Allentown, PA.