Medical Risk Adjustment (MRA)
How do we ensure reimbursement?
Med Group MSO ensures consistent physician and facility reimbursement by automatically evaluating provider claims under accepted industry coding standards thanks to a comprehensive nationally recognized code auditing system to secure consistent physician and facility reimbursement. We continuously enhance and update our code-editing technology to better enforce existing payment guidelines.
Claims are reviewed to:
- Ensure compliance with industry standards
- Verify that correct coding and billing practices are being followed
- Determine the appropriate documentation is submitted
- Improve compensation for our providers based on MRA.
We gather quality information and make it available to consumers, employers, health plans and doctors through these strategies:
- A thorough review of patients’ medical records, inclusive of patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, pathology reports, and discharge summaries
- Verification of diagnosis codes supported by the documentation in compliance with ICD 10 – CMS Guidelines for Coding and Reporting
- Encounters captured and submitted within the permitted time frame
Correct coding guidelines that we follow are established by:
- The Centers for Medicare and Medicaid Services (CMS)
- The American Medical Association (AMA) CPT Coding Guidelines
- National and Local Coverage Determinations (NCD/LCDs)
- National specialty and academy guidelines.