Category Archives: Risk Adjustment (MRA)
A Moment of Silence for the Sunsetting MRA Program – Part 3
This has been a difficult series of articles for our company, summarizing the 2024 changes to the CMS-HCC risk adjustment model. And we imagine our clients are speechless when considering the financial ramifications to their businesses. If you’ve missed any … Read Full Post
A Moment of Silence for the Sunsetting MRA Program – Part 2
By now, you may have come to terms that MRA, as we know it, is on its way out. If you’re not informed about the changes for 2024, we urge you to read the first installment of this article series. … Read Full Post
A Moment of Silence for the Sunsetting MRA Program – Part 1
Since the CMS-HCC risk adjustment payment paradigm took effect in 2003, our company has seen considerable changes, but this year takes the cake, as they say. Frankly, a moment (or really, a week) of silence would be appropriate to mourn … Read Full Post
MRA & FFS Normalization
This post is parenthetical to the series entitled, A Moment of Silence for the Sunsetting MRA Program. Although Medicare Advantage (MA) and the traditional Medicare program cover the same patients (called members in the former and beneficiaries in the latter), … Read Full Post
Medical Practice Owes for COPD & Morbid Obesity False Claims
Over the years, we’ve written many a blog post on risk adjustment compliance, advising our readers on ways to work successfully with this payment paradigm. And yet, almost every week, the Office of Inspector General (OIG) publishes notices regarding false … Read Full Post
Standards for Your MRA Department – Consider the Source
Since 2004, our company’s MRA work has undergone significant evolution, and we’ve worked on everything from isolated projects for a one-time client, to daily or annual reviews and even to serve as a client’s MRA Department. We presented some of … Read Full Post
Permanent or Past – What’s Your Evidence?
Evidence is vital in risk adjustment work, and not all evidence is the same, as we’ve blogged in the past. One area of growing concern is distinguishing between conditions that may be permanent and those which may improve and resolve. … Read Full Post
Recognized Diabetic Manifestations
Even people who know only the basics of risk adjusted payments know that there is a hierarchy in coding diabetes. Diabetes with no complications contributes about two-thirds less in funding when compared to diabetes with a complication. The unfortunate reality … Read Full Post
Medical Records & MRA
Everyone involved in health care knows that having historical information on a patient is important, especially when the patient is relatively new to the provider. The most meager of prior records still help to fill in the medical picture and … Read Full Post
Pitfalls in Chart Reviews: It’s not only about the Bottom Line
In this last blog in our four-part series on pitfalls, we thought we’d discuss the culture of your MRA department and how it guides the work. Our almost-20 years in this field have brought us into contact with practices and … Read Full Post