Services
Services
Case Review
HSAG has extensive experience and expertise in conducting medical record reviews and abstractions for state and federal clients.
Overview
Quality of care reviews
We assess whether the care provided meets professionally recognized standards of care.
Claims reviews
We make objective and accurate determinations of the medical necessity of the care provided and whether the documentation supports the level of care being billed.
Utilization reviews
Including preauthorization for services and concurrent and retrospective reviews. We assess the appropriateness, level of care, and medical necessity of the services provided.
Data abstraction
We review records to abstract data elements for validation projects.
Intent
What we do
HSAG’s projects vary in scope from record procurement and data abstraction to full case review and production of a final report of project findings. We conduct:
- Reviews of medical records, claims information, and other data sources to render fair and impartial decisions on medical necessity, quality of care, appropriateness of care, level of care, and length of stay.
- Abstraction of key data elements for performance reporting using defined criteria from patient charts, lab reports, imaging results, operative notes, physician notes, and prescription information.
- Annual reviews for Healthcare Effectiveness Data and Information Set (HEDIS®)1 accreditation for managed care organizations.
- Reviews of claims and the supporting medical record information to support clients’ fraud and abuse prevention programs.
Who we serve
HSAG has been conducting case reviews for more than 40 years, consistently providing excellent service for clients throughout the United States, including federal agencies, state Medicaid agencies, managed care plans, hospitals, and outpatient surgery facilities.
How we do it
HSAG works with clients to develop specific project plans that encompass statistically sound sampling, procuring medical records for reviews, conducting reviews and abstractions, and providing a final report, inclusive of data analytics.
HSAG uses evidence-based national clinical guidelines and professionally recognized standards of care to determine whether the quality of services meets the required standards. We also consider professionally developed norms of care, diagnosis, and treatment based on typical patterns of practice within geographic regions and factors associated with rural care.
Why HSAG?
HSAG has deep expertise from more than four decades of case review service, having performed well over 1 million medical record reviews. We currently perform approximately 100,000 reviews per year. With this experience in all types of case review, we have proven processes and infrastructure to handle large volumes of reviews efficiently. We have an excellent performance record that exceeds client project metrics for timeliness and satisfaction.
In-Depth Knowledge
HSAG has in-depth knowledge of Medicaid programs and requirements for 19 states and is an expert in Medicare case review. Our work is compliant with all federal and state regulations, ensuring accurate reviews every time.
Interdisciplinary Staff
HSAG’s multidisciplinary team includes highly skilled clinical and technical staff members experienced in case management, utilization management, managed care, and quality improvement initiatives. Physicians, nurse practitioners, nurses, and coders conduct the reviews and abstractions. They have proficiency and years of experience with Medicaid, Medicare, managed care, fee-for-service (FFS), developmental disability, behavioral health, acute care, and long-term services and support programs.
Tailored Services
HSAG customizes services, whether clients are seeking assistance to address an increase in reviews they usually conduct internally or they want HSAG to conduct all the reviews, including identifying suitable review criteria. We work with clients to design project plans, tools, and reports based on their needs.
FAQs
Frequently Asked Questions
Don’t see your question listed below? Please contact us. We are happy to assist.
Does HSAG procure the medical records to be reviewed?
HSAG will customize services to meet the client’s needs. We are adept at securing medical records from multiple locations and directly accessing electronic health record systems.
How does HSAG secure HIPAA compliance?
HSAG has robust internal information security controls to safeguard access to data based on the HITRUST Common Security Framework (CSF) and the National Institute of Standards and Technology (NIST) Special Publication 800-53 Revision 5, which exceeds Health Insurance Portability and Accountability Act (HIPAA) compliance requirements.
1 HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).