……SCB Services, LLC intends to hire experienced nurses and social workers to participate in the next HEDIS campaign as well as getting back to hiring for any and all entities that need Medical Record Review work. I can promise that paychecks will not ‘bounce’, trust fund taxes will be paid on a regular basis, all FLSA rules and regulations will be observed according to the DOL guidelines and everyone will be treated with respect, dignity and overall attention without regard to social standing, position within the company or how often the employee disagrees with me…the only way I become a better person is to learn from others…and I don’t have a husband involved in my business to run to and complain when an employee expresses an opinion that is different than mine…or, in many cases, if an employee expresses any opinion at all….
A few months after a Levy and after paychecks were withheld from employees from the ‘temporary worker’ side of my previous employer, I had vowed that I would begin a company that served the same, basic business community that my former employer had, however, I would do everything according to the laws of the Commonwealth of Pennsylvania. I have and I do….
Another common reason for requesting a medical record review is for litigation purposes. In fact, attorneys who specialize in personal injury or malpractice law often consult third-party medical experts to review all hospital and physician records, as well as depositions and affidavits relevant to the case. Individuals may also request a review to help them to better understand and evaluate the course of treatment undertaken to date and how to proceed going forward. This type of service is usually offered by specialty clinics and facilities, such as those providing services related to infertility, cancer or substance abuse and recovery.
A former client of mine is a Children’s Health Center in Northwest Pennsylvania. The entity requested SCB Services, LLC to provide them with LPN’s and RN’s that had community health experience to review records of all of the children in the treatment area with diabetes. This information was to be utilized for additional community health programs, etc. Another entity hired SCB to provide nurses and/or social workers to review medical records to determine which medication worked better for a particular age group. This information helps Doctors make better decisions about patients’ medical care. Medical Record Review (MRR) can be used for varied purposes for varied reasons but the primary consideration is the person that is doing the review….SCB Services, LLC has access to a number of the best nurses and social workers available.
What is HEDIS? The term ‘HEDIS’ is an anacranym for Healthcare Effectiveness Data and Information Set, which is a widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA). HEDIS was originally designed to allow consumers to compare health plan performances to other plans and to national or regional benchmarks. Even though it was not originally intended for trending, HEDIS results are increasingly used to track year-to-year performance. It is a component of the NCQA’s accreditation process, although some plans submit HEDIS data without seeking accreditation. An incentive for many health plans to collect HEDIS data is a Centers for Medicare and Medicaid Services (CMS) requirement that health maintenance organizations (HMOs) submit Medicare HEDIS data in order to provide HMO services for Medicare enrollees under a program called Medicare Advantage.
For the record, the ‘reporting year’ after the word ‘HEDIS’ is one year following the year reflected in the data; for example, the ‘HEDIS 2015’ reports, available in June of 2015, contain analysis of data collected from the ‘measurement year’ January – December 2014.
HEDIS measures can be added, deleted and revised annually. Measures may be rendered useless if legislation is introduced and passed that covers a certain protocol. Attention to seniors can prompt the addition of measures for screenings and treatments indigenous to this age group. Some concerns covered by HEDIS can be immunizations, cancer screenings, treatment after heart attacks, diabetes, asthma, flu shots, access to services, etc. New measures are introduced on a regular basis in order to maintain proper protocol or to introduce new.
HEDIS results must be audited by an NCQS-approved auditing firm for public reporting. NCQA has a service available for a fee that provides detailed data on all measures and is intended for employers, consultants and insurance brokers who purchase health insurance for groups. The NCQA website www.ncqa.org provides a summary of HEDIS results by health plan.
HEDIS studies or reviews generally run from January through May (or June, if necessary) and SCB Services, LLC will be providing HEDIS nurses and HEDIS experienced social workers to any and all of the major Medicaid/Medicare providers in the continental United States.
SCB Services, LLC has also done some interviewing and polling of 63 nurses in the State of Pennsylvania as to their experience with various HEDIS/MRR companies. Information is available for this purpose for those nurses/social workers who would like to have another kind/type of HEDIS experience.
Please contact Rosanne at firstname.lastname@example.org or at 484-798-1236 if you are looking for HEDIS or MRR positions or interested in filling HEDIS or MRR positions for the 2016 calendar year.