Are you ready for GPRO season?

November 10, 2014 Inovalon

For ACOs preparing for the upcoming GPRO season in January, now is the time to ensure you have covered all your bases for the following key components: staffing, record collection, data abstraction, tracking and reporting, as well as audit readiness.

Staffing can be challenging for ACOs during GPRO season. It is important to plan ahead and determine whether it is possible to create capacities for medical staff members to execute the medical record reviews without their regular workload suffering—or whether it would be better to outsource this task to a vendor. Choosing the most efficient process, while ensuring quality outcomes, is the first key decision for an ACO.

Record Collection
Accuracy of data entry, compliance calculations, and analyses are integral to laying the proper foundation for your submission. The right tool not only records reviewer data but also systematically calculates compliant, non-compliant, and exempt members based on CMS guidelines. Additionally, a robust tool should be coded in a manner that prompts for each review section to be filled out properly.

Data Abstraction
If you have the ability to interact with and abstract data from multiple EMR systems (most ACOs have multiple platforms), it can expedite the process--that is, if all your medical records are on EMRs and you are able to collect the data from each platform. However, even if you are able to accomplish this with only a portion of your data collection, you can still save time, money, and resources. 

Tracking and Reporting
Having a system that analyzes and understands the data you are collecting is very important. Insight into compliance, noncompliance, and exemptions not only helps with accuracy, but also assists with future planning. It influences strategy development, best practices, and procedures—all of which will be crucial for success in years to come.

Audit Readiness
The final step is to ensure that your reviewers and systems are prepared should you have an audit. CMS uses various methods to monitor and ensure integrity—including data analysis, site visits, collection, assessment, follow-up investigation of beneficiary/provider complaints, and business audits. An ACO “passed” when the percentage of mismatches per measure is less than or equal to 10%. If the mismatch is greater than 10%, the ACO “failed.” A “failed” status results in a lower percentage of shared savings, and each subsequent “fail” leads to further decreases for the duration of the contract with CMS.

2013 QMV Results
2013 audit results show how important preparation and readiness is for a successful, quality outcome. Out of the 50 ACOs audited in 2013, only 16 (32%) passed all audited measures assigned. The remaining 34 ACOs (68%) failed the audit due to mismatches.

Careful planning and readiness are essential for a successful GPRO season. For more information on how to prepare for GPRO season, click here to view our webinar, which addresses key success factors in more detail.

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