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
- 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.
Medical Quality/HEDIS
Is HEDIS mandatory?
All regulatory agencies mandate HEDIS annual reporting. As such, providers and their staff members must become familiar with HEDIS to understand what health plans are required to report.
Our Leading Physicians provide oversight for HEDIS in order to train and implement the measures needed to show how our Physician’s give great care.
To ensure the validity of HEDIS results, all data is rigorously audited by National Committee for Quality Assurance (NCQA) Certified auditors using NCQA’s process, which has expanded the size and scope of HEDIS to include measures for physicians, PPOs, and other organizations. Data is collected via HEDIS Data Submission, including Healthcare Organization Questionnaire (HOQ) and Interactive Data Submission System (IDSS
Coordination of Patient Care
Anticipation: the key to the patient’s care and safety
We organize and coordinate all patient care activities and share the information with all parties involved in patient care, to ensure effective and safe care. We make sure that care requirements are known ahead of time by the provider team.
Med Group will ensure:
- Team coordination to improve access and quality of care for patients
- Efficient methods of communication, including daily hospitalization reports
- Ensure follow-up of patients after hospitalization
- Track, monitor, and actively manage assigned patient cases to ensure coordination of care, retention of patient and review utilization level
- Retrieve all elements to build individual patient care record
- Interact with patient’s physicians and other staff, both within the clinic and outside facilities providing accurate and timely care
24-hour On-Call Service and Patient Review Services
Increase patient satisfaction will grow the revenue and maintain 100% occupancy.
Our proven method has got excellent results with all our previous customers. Med Groups consists of a 24-hour on-call service for all your clients with medical and mental health needs.
These professionals are available at your facility in addition to the 24-hour hotline.
With our 24-hour On-Call Service, you will have access to an on-site MD or ARNP provided to you. This will reduce the risk of hospitalization for your clients and give peace of mind that your patients can reach their PCP at any time.
Also, we help you maintain AHCA compliance by providing all required in-service training to your staff.
Pharmacy
Our comprehensive pharmacy management service includes:
- Organizing and reviewing pharmacy policies and procedures in every medical office
- Developing satisfactory methods of drug prescription and control
- Establishing quality specifications for all drugs used by PCP following the recommendations of the Pharmacy and Therapeutics Committee of CMS
- Record keeping, assuring quality, quantity, and timeliness of work done
- Reporting on trends and changes inside and outside the medical center
- Maintaining care competency as indicated by orientation guidelines for patients of all ages
- Establishing notification procedures for drug interactions and high-risk medications for geriatric patients
We will facilitate the process of credentialing primary care physicians with the medical plans for them to service their patients.
To become credentialed for the first time, you will provide:
- Attestation, signature and date
- Curriculum Vitae
- Work history (month/year format)
- Copy of DEA and/or CDS certificates
- Summary of pending or settled malpractice cases if applicable
- Copy of malpractice insurance
- CAQH information