Analysis of the Impact of Electronic Medical Records on Risk Adjustment

Under contract with the Center for Medicare and Medicaid Services (CMS), IMPAQ International, LLC with NORC is leading an assessment of the impact of electronic medical records on risk adjustment in the Medicare Parts C and D programs.  As a part of this study, NORC is conducting a literature review and environmental scan to explore how EMRs affect the quality and validity of data submitted for Medicare Advantage risk adjustment.  In the first year of the project, NORC conducted a thorough review of EHR software packages, diagnosis data capture in EMRs, and American Recovery and Reinvestment Act (ARRA) health IT provisions. The second year of the project focuses on the workflow aspects of diagnosis data transfer from EMRs to claims systems, clearinghouses and payers, examining diagnosis data capture and manipulation at each step in the clinical and payment processes before it is submitted to CMS. To support the study, NORC is leading discussions with key informants including providers, payers, EMR and practice management system software vendors, key standards organizations, CMS-HCC coding software vendors, and other relevant stakeholders. The results of the environmental scan and data analysis will provide a set of recommendations for CMS regarding the collection of diagnosis data from EMR products available today for the purpose of conducting Medicare Parts C and D risk adjustment.