Tag Archives: risk adjusted payment

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

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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

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Substance-induced Disorders may be Incorrectly Supported

From time to time, we run into risk adjusted conditions that are “newly discovered” by coders without fully applying the diagnostic criteria.  Those conditions are then suggested to providers, who may not be up on the requirements for the condition … Read Full Post

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Some MA Companies Used Questionable Means to Drive MRA Payments

The Office of Inspector General (OIG) audits Medicare Advantage plans for, among other reasons, to assure they submit accurate and true information to the Centers for Medicare and Medicaid Services (CMS) and thereby, receive proper risk adjusted payments.  The OIG’s … Read Full Post

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Risk Adjustment & the Specialty Provider – Part 3

Welcome back to our last installment of this three-part series on specialty providers and risk adjusted payments.  Part 2 of this blog series focused on the substance of consultation notes, while today, we  evaluate our topic from the perspective of staff … Read Full Post

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Risk Adjustment & the Specialty Provider – Part 2

In Part 1 of this blog, we reviewed the role of specialty providers in risk adjusted payments and their diagnoses of conditions that may fall under the CMS-HCC model.  In this installment, we’ll evaluate the substance of those consultation notes. … Read Full Post

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Risk Adjustment & the Specialty Provider – Part 1

Without a doubt, risk adjusted payments are geared to primary care providers (PCPs) and form the basis of Medicare Advantage plan payments and usually those of PCPs, whether directly (as in funding) or via surpluses or bonus payments.  The same … Read Full Post

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Hidden MRA Treasure – Part 4

In this blog series, we’ve been highlighting relatively unknown risk adjusted conditions or ones that bring some confusion; so far, we’ve looked at a few pulmonary disorders, most recently, bronchiectasis.   Today, we’ll consider the adrenal nodule, coded E27.9. Found above … Read Full Post

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Hidden MRA Treasure – Part 3

In Part 2 of this series, we spent a little time considering J84.10 and the specific diagnosis of granuloma of the lung.  In this installment, we’ll look at another oft-neglected pulmonary diagnosis of bronchiectasis, coded J47.9. According to the National … Read Full Post

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PMH isn’t Code-able – A Cautionary Tale

Before our discussion of the term past medical history (PMH), let’s briefly reflect on the risk adjusted payment paradigm, or MRA as it’s known in Medicare Advantage circles.  CMS bases the bulk of the capitation payment made to MA plans … Read Full Post

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