Risk Adjustment Audit Validation and Reporting Services

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Risk adjustment is a growing source of untapped profit potential; however, meeting CMS’s reimbursement requirements requires intensive resources. The guidelines associated with risk documentation standards require the submission of meticulously chosen and verified data for the risk scoring of patients (i.e. patient risk profiles).

The payer has the responsibility to provide the risk score information to CMS. The payers, in turn, are dependent on the physicians’ to diagnose and properly link the document for each high risk patient according to a strict protocol of necessary information needed for reimbursement. Working together, MiraMed can aid providers in understanding and providing the required documentation according to risk model methodology.

MiraMed provides:

  • Retrospective Risk Adjusted Data Validation (RADV) Auditing 
  • Concurrent Chart Auditing 
  • Risk Adjustment Educational Programs (CMS-HCC, HHSHCC, Commercial Exchange and Medicaid Managed Care) 
  • Physician Scorecards tracking Annual Wellness Visit Completion
  • Member Outreach
  • Annual Health Care Cost Assessment Program

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