HEDIS.tv Wrap-Up Live Stream

HEDIS.tv Wrap-Up Live Stream


hello everyone this is Steve Thornley
along with David DiVito and we’re here to talk about the end of the HEDIS
season here on HEDIS TV Dave why don’t you introduce our guests even though
they really don’t need an introduction why don’t you do it anyway okay well they’ve been with us before so if you’re fans of the show you guys already know
we have Kim Williams here who is a HEDIS expert and she is she doesn’t have
any scars left over from the HEDIS season so no new scratches or scars she
survived and then Charles Satterley who is in New York
correct Charles yes sir and he is a rock star and a HEDIS rockstar so both of
them survived this season they probably have some great battle stories to share
with us and we’re just excited to talk about and share with you how the HEDIS
season wraps up and what that means going forward Steve yeah so we’ve got
some questions and by the way if you still want your HEDIS geek bumper
sticker oh are just gonna pass over the just to do a little bit of housekeeping
we still have heat Eschete bumper stickers and you can get yours at your
local Walmart Walgreens no I’m just kidding you can only get them here
charles has his RS is okay cool but you gotta let us know that you’re
wat that you watch the show so you can email me Steve at Kerr national com
David at Kerr national com send us a smoke signal Beata garbage can ring the
dinner bell whatever it takes and we can still hook you up with one of these
great he does geek bumper stickers that the crazy thing about this is if you
really do put it on your car bumper no one will have any idea what you’re
talking about so you really need to put it somewhere where you know your friends
and coworkers it’s like honk fajitas right one of
those deals now that now that would be a good bumper sticker honk for HEDIS or
need us for HEDIS I like that Nina’s fajitas is a great slogan anyway so we
are we’re gonna be on hiatus obviously for the summer because there’s not a lot
going on with heat Asst there’s some right Kim there’s there’s stuff going on
but but just not as aggressively as as we just just were so yeah let’s talk to
you guys let’s talk about the season so who wants to start who wants to tell us
you know in in 90 words or less they’re 90 seconds or less what what was going
on how did it go if you’re not first you’re last isn’t interesting
this year we kind of had a slower influx of charts
they came instead of in large dumps of records they came in kind of small
dribbling amounts all the way through the project my team actually touched
over 23,000 members so they stayed incredibly busy they get nominal job and
and of course we are after abstraction so that were missed from the claim
system or from immunization registries that we were able to tap into so
altogether it was exhausting and successful very good what about you
Charles hi guys yeah interesting years well we must be
the the season we had also slow influx steady but slow we had a big
all records come in through our first mailing with a long client or the client
um we they do their own collection we did my team just did on its and we we we
surpassed you a little bit can we did about 25,000 members just on its so
those numbers were submitted on Tuesday we’re waiting to hear back that we’ve
passed the audit first round and that would be just top won’t be heated
seasoned perfectly my other client was still going we’ll go until the 25th so
we’re extended a little bit and we are just some of the 3,000 with that they’re
a smaller plan and continue to work nice nice so one of the questions that I kind
of have right off the bat is and what probably this be more for Kim because
she was doing the front end what what were the were there any challenges
presented with the new CMS requirements for 2018 and if so what were those
challenges which challenges are you talking about
well let’s name your top three how does that sound plenty to choose from
no we didn’t we didn’t face any challenges as far as new CMS
requirements of course we do commercial instead of okay
okay all of our challenges were of course getting providers to acknowledge
that they did see the member on 25 different occasions even though they
said that’s not my patient gotcha so we’re your abstractors also your
chart chasers or did you have two people doing the chart chasing actually is the
staff that pursues the record we have an abstraction team and then my
research team so it is they faced a lot pursuit faced a lot of challenges this
year it’s just you know hearsay information I was telling Charles before
we started we found out that some plans were for providers were ever even asking
for payment some plans were free paying providers Wow I know that they are
flooded with requests every possible for him and the United States dollars and um
but it was really it was really more challenging I think seasons than any
other seasons England records hmm okay what about for for you Charles what what
were some of your challenges right now our challenge is one of my clients is in
Massachusetts in there are I had a significant amount of my chases were
single one or two charts from these providers that are in these rural areas
and getting them to get contact with them getting the proper address fax
number contact person following up with them and getting them to send us the
records was Mozart’s biggest challenge right now this larger sites where we
were able to send in em our team at the record tech on site to collect the
records we didn’t have as many of those this year we had a lot of outside
agencies like he was stating that were holding all records hostage and so we
submitted payment for them and that’s really not how it works
all right we didn’t have any prepay incidences but you know they do a lot of
I sent out some so you know letters request letters with big second notice
final response you know this is due by such and such a date and some of them
respond more to that you know I have a great team based out of Florida
through my record collection this year and they are very aggressive and we are
steadily reaching towards our 95 or better percent of collection you know
you know that boy that is though that that occurred is because there’s a lot
of retired Italians in Florida would you say that Dave here we go yeah none of my
relatives unfortunately but yeah those charts
break a leg literally right figuratively and literally they wouldn’t have been
holding you back in that case for sure we have made things happen quick all
right wonderful well we’re we’re up for our first break so we’re gonna take a
quick quick break we’ll be back with Charles and Kim and Dave sorry I don’t
mean to leave you out but welcome to my world international Oh welcome to med
review a leading audit an independent review organization with 40-plus years
of service to the healthcare industry providing medical reviews quality audits
and health services management our goal is to improve the world of healthcare by
helping your organization preserve quality control expenses and boost your
bottom line med review serves health insurance companies government agencies
attorneys and labor organizations med review provides quality surveillance and
independent medical evaluations utilization management managed care
assessments medical audits and reviews including DRG coding validation HEDIS
and quar charge audits readmission review and more to find a winning audit
and review solutions for your organization’s challenges contact med
review now at two one two eight nine seven six thousand or med review us you thank you thank you to all the nurses
who inspire us with your work to all the nurses who embrace innovation
and to those whose influence has shaped the world of healthcare as we know it
today your hard work and dedication does not go unnoticed
so from us here at Kerr national thank you thank you thank you thank you thank
you thank you thank you thank you hello everyone welcome back David DeVito here
with Steve Thornley on the final heat is broadcast of the season and we are with
Kim Williams and Charles Slattery as well guys I have a couple questions for
you really quick I know that as we’re wrapping everything up right now that a
lot of people are looking for you know opportunities that they can work on
through the summer and into the fall and also so really what types of positions
can nurses maybe be looking for or opportunities but also what advice do
you have someone really at any level that participated in HEDIS to maybe
prepare themselves better for next season we have quite a few people that
are being asked back by our clients and say hey you did a great job this year
we’d love to have you back next year is there anything maybe in the offseason
that they can do to better set themselves up for success next year I
always advise my staff to read the audits or the oval reads that I’ve done
for them because they can always they can’t learn people become defensive
about making mistakes and I always tried to tell my staff when I audited Oh work
it’s not about you need to defend your work it’s about you need to learn from a
mistake so re reviewing their audits or their
overeats to identify some of the errors that they made I always think that they
need to follow the NCQA sign up for their updates really in
Meishan and if they want to branch out some people are kind of pigeon-holed
into a small number of measures when they get their fetus job if they want to
brush up on the other measures so make sure that they read all of the standards
on you know what is compliance and their allowable providers and and what are we
looking for so I think you can do a lot during the off season
prepare yourself or for your next news great advice Charles you have thoughts
on that yeah I agree with Kim it’s always unfortunately NCQA does it come
out with the new specs from the next year until after the end of October or
early November so that’s if any changes are being made that’s when you need to
brush up on that stuff but over the over the summer you know it’s a great idea
it’s going over with your staff any kind of points or mistakes that they’ve made
and it’s all learning experience I you know I don’t like to be caught with with
making mistakes and it’s it is a pride ego thing at times and you’ll debate
back and forth there’s some gray areas within some of the specs so
interpretation is big and everybody being on the same page with interpreting
the data as whether it’s compliant or not and that’s always good to reinforce
that during the downtime so that you know it’s not a learning curve once you
get going that that learning curve has already been established and you know
you do a better job each and every year we had a really great team of reviewers
this year with my one client and that’s what we did were audits and we we found
the significant amount of mistakes that would have failed on it if they got
pulled you know so I’m really proud of the team that I had worked with this
year and it’s all due to all the extensive training that we did and yoga
reads and and following up with any of the new measures and
also right one point I have we did 12 measures 614 measures you know another
client we did nine measures so it is good to know you know the more
experience you have with the the criteria that better that’s great advice
guys thanks yeah absolutely and you know this might be a good time to kind of
jump in and talk about our heat of certification now we don’t have a lot of
information to advertise about that right now but we will have our website
up here hopefully in a couple of days which is Heda certified calm and care
national in conjunction with the lovely Kim Williams we will be putting that
program together and starting it hopefully in the summer so if you don’t
have you know if you don’t have heaters experience and you want to get involved
there’s finally going to be this opportunity for you to get certified by
us and then hopefully get placed by us or or through other other measures so
don’t want to let too much of out of the bag yet about that but visit heat is
certified calm and we’ll have that going probably here within the next two or
three days with a little at least some basic information for you we now want to
continue on with the QA because we have some people that really want their heat
Eschete bumper sticker right so of another question yeah I’ve got a
question Dave’s got a couple questions and we’ll just kind of go from there so
this one was actually directed towards Kim from Cathy W I’m not sure where
Cathy W is from but she wanted us to her question is can you explain the
difference in HEDIS abstraction and he just reached
what’s the difference if there is any I didn’t know there was but it is is there
a difference between the research and the abstraction the research team Steve
the people on my team have to have at least at least two years of experience
okay new abstraction we help out if there’s a large influx of records we
help with abstractions like our art so they are cleared to
abstract we actually are in the hiring process I explain to people we are
actually abstractors okay look at what the abstractors have done if we free
price but we also have access to deplane search them so if there isn’t compliant researchers identify a new case or a new
provider based on the claims data so we research where there could be compliance
okay we also researched what the abstractors already done so okay okay
that’s good to know that’s good to know because I didn’t
know I didn’t know what the differences were there Dave what do you got for them
yeah we got a question from Julianne and it sounds like Julian’s wrapping up a
project right now because her question is what do you recommend spending your
final few days focusing on a hundred percent over reads or inching the
measures to the next percentile can Kim can I take that one looks like she wants
to arm wrestle you have a question but yeah so that’s a great question and that
exactly is exactly where my one planet we’re working with right now is doing
they are we’re working numbers to see how many outstanding chases we have as
opposed to how close we are to the next rating and meaning our benchmarks go
75th or 98th percentile so there would be a focus in on a certain couple of
measures that we are close on some of them were not you know the numbers just
don’t work out where we’ll where we’ll meet or exceed we want to do at least as
well as we did last year but usually they want to get the next rating is
where their focus is going to be on of course you need to do over reads because
if they get picked they want to be compliant you know you want to be a
hundred percent sure but is a there’s a would be a focus on getting the hits
awesome interesting yeah thank you that’s all I
have for now but always know you know that you asked the first question I did
yeah I’m really talking about that awesome okay cool
so what do you what do you guys see coming up for next season I mean I know
that sometimes the announcements from CMS don’t get made till till later in
the year but I mean what do you anticipate you antipas anticipate that
there’s that this is just gonna keep building as far as you know the the
demand for heat is I know we had our best HEDIS season ever probably with the
number of people that we placed absolutely especially with one of our
one of our clients we were actually recognized by one of our national
clients for didn’t we have the most heat as people of all their other suppliers
you said we were their top supplier which is an incredible honor coming from
where it came from so very happy about that and my team’s involvement yay guys
yeah this is this is a company that’s like you know top 4 in the nation
as far as health insurance organizations so that’s that was definitely a good
accolade but yeah what do you guys what do you guys what do you guys think is
gonna happen for the next season any comments on that I think that you’re
right Steve I think we’re gonna also see as people become more acclimated and
more trained in Thetis there’s going to be quite a bit more competition for the
positions that are available I see a little bit of change as far as and no
offense to Charles but all of the clinical demand I see a lot of coders
coming into etus hmm very you know and hence well people don’t have the
clinical background there is that means for an additional training as far as he
this is concerned but they outsourcing not produce the results some of the
health plans there’s language barriers there’s medical concepts so you’re
talking about offshoring yes I don’t think it’s that a lot of
health plans have found that it’s not producing the results that they hoped it
would we thought that we’re going to be saving and they’re staffing fund saving
that money I think has created even more complexities with the language barrier
with medical terminology with their concept and understanding as far as as
what we do I cannot say that I’m upset about that because I think that it
should all stay here with us I think there is enough here as far as
people and and companies and staffing vendors in the US for us to be able to
do it can do it yeah interested to know your take on that Charles because I know
that that’s we’ve seen a lot of that we’ve seen a lot of kind of the
offshoring what what’s your take on on that Charles yeah I have a mixture of
that because part of the company I work for does have a little short office that
is is part of our company so they want to supply them with work and help them
out sir but the other you know there there are certain contracts city
contracts and stuff like that that have built in the moments in there that don’t
allow that that have to keep the work here but I think you know it all depends
on the client and the clients needs I get a little bit you know the last
conference there’s a lot more coding going on with medical records and not as
much hybrid data analysis so we got to be careful on how much staff we really
are going to need as far as what what measures are going to be satisfied by
claims do and not really need a full medical
record review so that kind of is an interesting to see where we’re going to
go with that they are developing new measures every year that are designed on
a hybrid of medical record review so we will always need that and and but on the
back end when they run the claims if they’re satisfying a lot of the measures
which claims data you know the need for a reviewer is not there necessarily so
I’m anxious to see where we do go but there are all different types of audits
coming around yeah this dis reports there’s a CEO on it
so the people who are doing not necessarily just focusing on heaters on
it’s there or there are other opportunities out there to do help get
quality arms really quick before we cut to break do you see more opportunities
for people to work in this kind of quality management area on a year-round
basis doing like some of those other things like the ACO audits and and
things like that yeah you see that increasing yeah they’re gonna start
becoming more popular I think then etus audits there are different times to the
ACO organizations the group providers are over and start doing these other
types of audits once in a in a measurement year changes it’s not your
day you know January 1 to 12 31 it’s it’s if
you’re if you’re on their own they measure the years but so there’s going
to be opportunities to stay busy year-round
coming up ok awesome well I know that that’s gonna be news to a lot of
people’s ears why don’t we take our last break we’ll come back and we’ll do a
final wrap-up for the season and get to the final thoughts we’ll be back right
after this welcome to med review a leading audit an
independent review organization with 40-plus years of service to the
healthcare industry providing medical reviews quality audits and health
services management our goal is to improve the world of healthcare by
helping your organization preserve quality control expenses and boost your
bottom line med review serves health insurance companies government agencies
attorneys and labor organizations med review provides quality surveillance and
independent medical evaluations utilization management managed care
assessments medical audits and reviews including DRG coding validation HEDIS
and quark charge audits readmission review and more to find a winning audit
and review solution for your organization’s challenges contact med
review now at two one two eight nine seven six thousand or med review us hello everyone welcome back David veto
with Steve Thornley Kim Williams and Charlie Slattery we’re gonna wrap up the
heater show Steve yeah and finally I just have to say that my final thoughts
on on the season it was fantastic and you know interestingly enough we didn’t
have a lot of like employee I guess issues if we want to call it that
everybody kind of you know put the nose to the grindstone and I think the word
is spreading now that there’s a huge need here and hopefully next year like I
said we’ll be able to get people involved in and HEDIS that you know
maybe just have a good clinical background maybe they’re an ICU nurse or
something like that they just want to do something you know a little bit
different so that’s what I’m hoping for with with the certification program that
we’re putting together and things like this but what I mean your your
department really placed a lot of the like the medical assistants that did the
chart chasing I like to call it chart chasing you guys call it pursuit team
it’s you know tato potato but yeah what are your thoughts I think a lot of our
success this year really was based in the communication levels that we had
with the people that were out in the field constant communication just
fantastic interaction both with the managers themselves with our clients as
well as our people that we put in place so I think that that higher level of
communication really helped us avoid some of those issues
Steve honestly and really kept the flow going if there were any issues from an
employee standpoint those were identified pretty quickly and we were
able to work through those with the hiring managers so again to everyone
that we worked with out there whether you were a candidate that we had placed
in a role or whether you’re one of our clients that we worked with that one
just a heartfelt thank you to everyone out there because there was a lot of
work and it took complete teamwork on everyone’s part really to achieve a lot
of the results that we’ve had and you know we were fortunate that I heard back
from a lot of hiring managers that as they started to cut people off they kept
a lot of our people on I was really proud of the fact that our people were
identified as yeah to keep them onboard till the end
and really help them wrap it up and a lot of those people again have been
invited back next year it’s extremely proud of that and I wanted to thank Kim
and Charles for your involvement in the shows as well because without you and
your expertise none of this would be possible right yeah we only know part of
this and that’s the employee part but you guys are the real experts what are
your what are your final thoughts Kim you want to give us your final for
the for the final finale yeah yeah I think it was congratulations to you all
I know how much you put into recruiting and pre-screening and and placing the
right people and in the right positions and that there is a definite benefit to
somebody that knows how to help that person get their foot in it or whether
it’s their first season or their tenth season the right position for somebody
is its paramount you know you always over hire due to attrition you see
people that can’t make it you see people that are incredibly intelligent but
their focus is somewhere else so sure it’s like herding cats all right Charles
you get the final world she she may have got to go first but you get the final
you get the final word so yeah so first of all I want to wish all my fellow
nurses happy Nurses Week it’s Nurses Week this week absolutely you know
without the my teams this year I would have not been able to get what we
achieved on they were tirelessly they were over they were over trained and and
it showed they we we we finished strong with the one project we’re finishing
strong with our other project it just takes a lot of dedication it takes the
logistics everything worked this year we had no issues with our logistics were
people logging in the the the tireless effort of
collecting the records and like David was saying the communication I’m on the
phone daily with my teams and there was open lines of communication we all
stayed on a group text or a group email so that if one person had a question
maybe the other person someone else had the same question and it all got
answered and we all you know conference stand on certain issues that we
identified issues we resolved them right away so that moving forward everything
worked out well giving people opportunities in this field is paramount
like Kim said somebody gave me an opportunity and now you know all the
hedging projects and it’s just a great great experience um I don’t think I lost
as much hair as I did yeah I end up in the ER this year actually here my hair
out longer you know this earth it was totally butch last year but yeah
and and I can’t believe it’s you know we’re in the second week of May in and
we’re finished up already it was an amazing season I want to thank you two
guys for for having me on the show absolutely introducing me to Kim who’s a
valuable resource she and I speak every once in a while
and just you know a school that has that’s what we’re all about is bringing
people together right Dave we’re very unifying well one love it’s all good I
feel like you know I feel like since it’s like we’re going into summer like I
should be signing or guys yearbook right now like hey congrats on a great heat of
season have a great summer it’s graduation day yes graduation day but we
will be back and in fact Cara national we will start recruiting in August late
August but in August we’ll start gearing up because we know that people are
starting to kind of think about heat of season at that point so make sure to
head over to our careers page at careers care national comm we’ll start posting
you know some of the needs and also just another plug for the heeta certify comm
will have that that going in a couple of days here so
people can start looking into that Dave now I’m gonna give you the last last
last last of the word well I’m gonna give one quick shout out to – RJ Mendoza
who does our work yeah RJ see all the video so you know he signs autographs
he’s he’s he’s the true he’s the true he this rock star technical difficulties
are not difficult for him so he’s got it and we had plenty of that but again
thanks to everyone care national sincerely believes in really doing
what’s best for the candidates and for our clients and it’s been a pleasure to
work with Kim and Charles and people who share that same vision of really doing
what we can to make what is otherwise a very difficult project and season as
easy and as smooth as possible I’m honored to be a part of all of it and
learning every year and looking forward to next year and you know following
through in the summer and really making things happen and getting us all ready
for another successful season next year and we might as well end on with our
favorite tagline because in 2019 what are they gonna need they’re gonna need
us for heat us perfect all right take care everybody we’ll see you on our
September Show for 2019

1 thought on “HEDIS.tv Wrap-Up Live Stream”

  1. This is a great video. I am going to be starting my first HEDIS project in December and I am very excited. I am a certified coder with a few months' of experience. Prior to that, I have worked as a medical record reviewer/abstractor for med-legal reports for eight years and prior to that as a medical transcriptionist for 12 years. I have become very interested in the risk adjustment coding and HEDIS realm, but mostly HEDIS. I have been studying HEDIS measures for a few weeks now and just feel that I will absolutely love this type of work. As stated, I am a certified coder, but I do see that a lot of opportunities are available for LPNs and RNs, so I am definitely considering going back to school so that I can eventually secure a career in the field of HEDIS. Thank you to all who was involved in the making of this informational video! It is very helpful!

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