Risk Adjusted Reimbursement (MRA)
Chart reviews are in-depth audits that assess the provider’s understanding and compliance with proper documentation and coding, thus validating submitted information to ensure proper payment. Reviews are accomplished after extensive data analysis, and encompass as much historical information as necessary to assure a complete understanding of the patient’s health status.
Our MRA Specialists focus on three areas:
- Documented risk-adjusted diagnoses that were improperly coded using non-risk-adjusted codes. In these cases, we will prepare encounters for submission to the Plan.
- Reported risk adjusted diagnoses that are not substantiated by the provider’s documentation and which must be removed from the patient’s diagnostic profile. This step requires provider feedback to impart an understanding of the correct documentation required in the future.
- Conditions evident in the patient’s medical chart, which have not been previously recognized, documented or reported as risk adjusted conditions by the provider.
Because chart reviews provide an accurate picture on the day the record is audited, our approach is to create an educated medical practice that is fully conversant in the activities that bring MRA success so they can all “do it right the first time.”