SCIO Health Analytics® launches SCIOClarity™ Chart Validation services for Medicare Advantage health plansView as PDF
Chart Validation service ensures complete and accurate documentation of diagnosis codes via retrospective analysis of member medical records.
WEST HARTFORD, Conn. – June 27, 2017 – SCIO Health Analytics® today announced the launch of SCIOClarity™ Chart Validation, a new service for Medicare Advantage health plans that ensures complete and accurate documentation of ICD-10 diagnosis codes via a retrospective analysis of member medical records. Health plans can use the service as a part of their overall efforts to ensure optimal performance in their risk adjustment and quality programs.
SCIOClarity™ Chart Validation addresses the problem of inaccurate documentation of member diagnosis codes. There are many reasons why a diagnosis code may not be accurately documented, including: errors in translating physician notes to ICD-10 codes by medical coders, system limitations on the number of diagnosis codes that can be included in a chart, and codes being dropped during transmission between stakeholders.
The consequences to health plans of inaccurate documentation of diagnosis codes can be significant. Poor documentation practices can lead to a health plan being under-reimbursed for that member, negative findings in Risk Adjustment Data Validation (RADV) audits, and the appearance of quality measure gaps that have already been closed.
SCIOClarity™ Chart Validation services offer the ability for health plans to improve their risk adjustment and quality programs in two important ways. First, by capturing previously missing diagnosis codes, health plans will benefit from more accurate risk adjustment factor and quality measure scores. Second, when the service validates or corrects existing diagnosis codes, the organization can be confident in their ability to perform well in RADV audits.
The Chart Validation service consists of several elements, including leveraging risk adjustment analytics to create a suspect list of members that may have coding issues, acquisition of medical records from primary care providers and clinical chart review and coding valididation.
With the launch of Chart Validation services, SCIO Health Analytics® has rebranded its risk adjustment and quality solutions as SCIOClarity™ and now serves as a comprehensive offering for risk adjustment and quality analytics, inpatient data pursuit services, member outreach and provider engagement services.
“As risk-adjustment and quality programs become increasingly tied to health plans’ financial performance, ensuring accurate documentation of diagnosis codes takes on a critical level of importance,” said Tom Peterson, senior vice president of care optimization and risk adjustment with SCIO Health Analytics®. “By conducting a retrospective analysis of member records, SCIOClarity™ Chart Validation services enable health plans to capture missing or incorrect diagnosis codes, leading to appropriate levels of reimbursement and better performance in risk-adjustment audits.”
SCIO Health Analytics Contact:
Michele Norton, M.S., R.N.
Senior Vice President Marketing