Risk Adjusted Reimbursment (MRA)
Chronic diseases—such as heart disease, cancer and diabetes—are the leading causes of death and disability, accounting for 70% of all deaths in the U.S., which is 1.7 million each year. (Source: CDC) It’s no secret that patients with one or more chronic conditions generate higher medical costs.
To better cover those medical expenses, Risk Adjustment attempts to fund MedicareAdvantage plans based on their patients’ health status as summarized by the ICD-9-CM codes submitted by all providers treating a patient. Its goal is more accurate funding based on a member’s health status, which is reflected in the patient’s Risk Score. Since many medical groups bear the financial risk of the care of MedicareAdvantage patients, proper documentation and coding are paramount to correct funding and overall company profitability.
Coleman Consulting Group is a local pioneer in MRA. Since 2003, the company has worked with health plans and providers of all sizes and types: solo practices, staff-model offices, small & large groups as well as MSOs. Our strengths lie in our in-depth knowledge of the entire MRA process and our solid command of risk contracts from the operational and financial perspectives. To put it simply, we speak MRA!
Our educational approach never fails to elicit clinician buy-in and compliance, and our audit techniques solidify provider knowledge and command of this payment paradigm. Our goal is to change clinician behavior and create a culture of provider support within the practice. These are the keys to success with MRA.
Because MRA success and compliance are multi-faceted, our services are tailored to each client’s unique characteristics and include some or all of the following: