Category Archives: Risk Adjustment (MRA)

Documenting Manifestations: “Connect” with an Accurate Payment

Over the years, we’ve seen it all when it comes to physician documentation.  One physician in a group insisted that if she wrote all the conditions on one line, they were connected.  Her partner’s charting habit was using slash marks … Read Full Post

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Alcohol Abuse vs. Dependence: Is it Fraudulent to Knowingly Soft-Pedal a Diagnosis?

Do you think a provider would chart heart disease for a patient with – say – hypertrophic cardiomyopathy because it’s a ‘warmer, fuzzier’ diagnosis? Or try to scare a patient with metabolic disorder into losing weight by diagnosing her prematurely … Read Full Post

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The Top Three MRA Mistakes: How much are these costing your practice?

When a medical group’s risk score is low despite a chronically ill patient population, the culprit is generally one of three very common practitioner habits. Let’s explore each one: Failure to connect diabetic manifestations: This is probably the low-hanging fruit … Read Full Post

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Why should I use a Consultant?

Question: Why should I use a Consultant? Answer: The dictionary defines a consultant as a person referred to for expert or professional advice. At Coleman Consulting Group, we believe that using a consultant can be the best of both worlds: … Read Full Post

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Why is my Risk Score so low when my patients are so sick?

A risk score is a numeric representation of the health status of your patients based on factors developed by the Centers for Medicare and Medicaid Services (CMS). Each patient has a risk score and your practice has one too. The … Read Full Post

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How does provider reimbursement work?

There are two common methods of reimbursing physicians: Fee-for- service (FFS) and capitation. There are also two major code categories in use by most primary care physicians: ICD-9-CM codes and CPT-4 & HCPCS codes. ICD-9-CM codes (soon to be replaced … Read Full Post

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What is MRA?

MRA – Medicare Risk Adjustment – was established in 2003 and phased in over a five year period. Through this payment methodology, the MedicareAdvantage Plan’s (and the provider’s) capitation is adjusted based on the risk assumed for the patient’s care, … Read Full Post

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