MRA Coding Services | Medicare Risk Adjustment Coding

100+

Satisfied Clients

30%

Practice Revenue Rise

99%

Collection Rate

Comprehensive MRA Coding Services

Having problems capturing the diagnoses of your Medicare Advantage patient population? Our Medicare Risk Adjustment (MRA) coding services provide the solution!

Healthcare providers need to receive fair compensation for treating patients with varying levels of health risks, especially those with chronic or severe conditions.

Medicare Risk Adjustment (MRA) coding plays a vital role in ensuring you are appropriately reimbursed based on the health status and risk profiles of your Medicare Advantage patients. Our comprehensive MRA coding services help optimize your revenue by ensuring accurate and compliant documentation of patient diagnoses.

To support greater consistency and reliability in MRA code assignment, our team utilizes MedGenX, OSI’s automated medical coding platform, which streamlines chart review and enhances documentation clarity.

Accurate Diagnosis Coding for Enhanced Risk Adjustment

Accurate MRA documentation is crucial for capturing the full picture of a patient’s health status, ensuring that Medicare Advantage plans reflect the appropriate level of risk. This not only ensures you receive proper payment for the care you provide but also minimizes the risk of audits, payment delays, or penalties due to incorrect code assignment or incomplete documentation.

The HCC model uses ICD-10 codes to categorize patient diagnoses into different hierarchical condition categories. As experts in Hierarchical Condition Category (HCC) capture, we can ensure that all diagnoses are captured accurately and comprehensively. Our team leverages MedGenX to validate code specificity, reinforce adherence to CMS risk adjustment rules, and maintain consistent code accuracy across large volumes of charts. This allows us to deliver strong audit readiness, reliable HCC capture, and a more stable risk adjustment foundation for your Medicare Advantage population.

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Our MRA Coding Services: Comprehensive Compliance and Audit Support

Our MRA coding services ensure that submitted diagnosis codes meet risk adjustment submission requirements (set by the MA plan).

Our support includes:

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Expert documentation support

Our certified coders specialize in MRA and HEDIS coding, ensuring accurate documentation of chronic diseases and HCC codes in alignment with CMS requirements and quality reporting standards.

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Thorough chart reviews

We conduct detailed chart reviews to capture all diagnoses accurately, preventing missed risk adjustment opportunities and underpayment. Our automated medical coding software supports this process by assisting our team in reviewing large chart volumes quickly and flagging documentation gaps.

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Compliance with CMS guidelines

Our services ensure adherence to CMS regulations, staying updated with changes to minimize coding errors and penalties.

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Verify patient information

We verify patient details, including demographics and medical history, to ensure assigned codes accurately represent the patient’s current health status.

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Internal audits

We conduct claim audits to ensure all correctly documented diagnosis codes have been submitted, including both retrospective and prospective audits. MedGenX’s audit mode further supports this by re-checking past coded records for compliance and missed revenue opportunities.

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Monitor coding trends and patterns

Our team tracks trends to identify potential issues early and implement improvements before they escalate into larger problems. With AI-supported analysis, we can detect unusual code patterns sooner and strengthen overall risk adjustment performance.

By ensuring the accurate capture of HCC codes and relevant patient diagnoses, we help you maximize your reimbursement potential. Our skilled team makes sure that all conditions are properly reflected in the risk adjustment process, so your practice gets paid for the level of care provided.

Benefits of Our MRA Coding Services

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High Accuracy

Our coders have deep expertise in MRA and HCC documentation, ensuring that all diagnoses are captured thoroughly and accurately. With support from MedGenX’s AI-driven validation, we maintain consistent code precision across large volumes of charts.

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Optimized Revenue

By capturing the complete health status of patients, we help you receive the appropriate compensation for complex cases. Our intelligent coding review process strengthens documentation completeness, which supports more predictable reimbursement.

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Reduced Risk

We help reduce the risk of audits and denials by ensuring compliance with the latest CMS guidelines. Automation adds another layer of review, helping us detect inconsistencies that could trigger compliance issues.

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Streamlined Processes

By easing the burden of risk adjustment documentation, we help physicians focus on patient care. Our hybrid approach of skilled coders supported by automated review capabilities allows for faster turnaround and smoother workflows.

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We serve all 50 states

Why Choose Us?

Experienced certified coders
AI-driven code assignment
Customized solutions
Compliance driven approach
Proven track record
Stringent QA
30 to 40% cost savings

Flexible Pricing Options

Choose from our transparent and cost-effective pricing models:

Full-Time Equivalent

In this model, services are billed based on the equivalent cost of a full-time employee (FTE) for a specified duration, usually monthly or annually.

Per Verification Billing

Like an FTE model, a person is dedicated to your practice. Perfect for a practice that is busy. They work as an extension to your business.

FTE/Per Verification Billing

This option is ideal for a practice that is unsure about their work requirements. This can have per request pricing for eligibility and other functions.

Healthcare and Dental Revenue Cycle Management Process

Ensure Accurate Risk Adjustment with Our Expert MRA Coding Services!

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FAQs

How does accurate MRA/HCC coding impact healthcare organizations financially?

Accurate coding directly influences the reimbursement received by healthcare organizations caring for Medicare Advantage patients. Proper coding ensures that providers are adequately compensated based on the health risk of their patient population, contributing to financial stability and enabling the delivery of high-quality care.

What sets your services apart from others?

Our MRA/HCC coding services are distinguished by a meticulous approach to data collection, certified coders with expertise in Medicare coding guidelines, and a commitment to continuous education and improvement. We prioritize accuracy, compliance, and collaboration with healthcare providers to optimize the risk adjustment process.

How do you ensure compliance with CMS guidelines?

Our coding processes adhere rigorously to CMS guidelines, with regular updates to reflect any changes in coding requirements. Internal validation and auditing processes are in place to ensure strict compliance, and our team undergoes continuous training to stay current with CMS regulations.

How frequently should MRA coding be updated for accurate risk adjustment?

MRA/HCC coding should be an ongoing and dynamic process, continually reflecting changes in patient health status. Regular updates, ideally concurrent with patient visits, help maintain accuracy in risk assessment and reimbursement, contributing to a more precise representation of the patient population’s health risk.

How do you collaborate with healthcare providers to improve code accuracy?

We establish a collaborative feedback loop with healthcare providers, offering education on accurate documentation and coding practices. By combining provider insights with automated checks from MedGenX, we help ensure that documentation is complete, clear, and aligned with risk adjustment guidelines. Regular communication, training sessions, and data-sharing foster a partnership aimed at enhancing coding accuracy and overall risk adjustment effectiveness.

How does automation help you manage large MRA workloads?

MedGenX supports our team by handling bulk chart processing tasks that would otherwise slow down manual review. This helps us process high volumes of MRA charts without compromising quality in a shorter timeframe, especially during peak reporting seasons.

Optimize Medicare Advantage Reimbursements with Expert MRA Coding Services