Risk Adjusted Reimbursement (MRA)
Data Analysis allows us to identify anomalies and discrepancies in the practitioner’s activities. CCG reviews inpatient claims, PCP encounters, other outpatient data and even pharmacy information to ascertain the patient’s reported health status. By reviewing this data, our staff can spot issues with ICD-9-CM coding that facilitate more targeted and accurate auditing and education activities.
This enables us to stratify the client’s patient population and target patients whose diagnostic profiles reveal variances from the norm.
Because submitted data can differ greatly from the data received by the Plan or CMS, our company uses proprietary computer models as well as staff review to identify software issues or actions by third parties, such as billing companies or clearinghouses, that impact proper funding.