Risk Adjustment Solutions

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MiraMed is experienced with the CMS-mandated criteria for risk adjustment. Successful adherence to risk adjustment protocol allows for the moderation of payments and the balancing of disproportionately high-risk patient populations with lower-risk patient populations, minimizing the effect of the health status of the covered population. MiraMed can aid providers in understanding and providing the required documentation according to risk model methodology. MiraMed has the ability to maximize the potential patient risk based on the clinical documentation and diagnosing for each high risk patient according to a strict protocol of necessary information needed required for reimbursement.

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MiraMed provides:

  • Retrospective Risk-Adjusted Data Validation (RADV) Auditing 
  • Concurrent Chart Auditing 
  • Physician Scorecards
  • Annual Wellness Visit Scorecards
  • Population Health Assessment
  • Annual Healthcare Cost Assessment Program
  • Educational Programs
Concurrent Chart Auditing

MiraMed has perfected a unique process for concurrent auditing which involves “upfront review” of physician supportive documentation for diagnoses reported on encounters during face-to-face visits prior to submission into billing systems. Read More


Retrospective Chart Auditing
MiraMed has a robust, thorough process for conducting retrospective auditing which involves reviewing documentation and encounter data on past dates of service (within the current or previous reporting year) that have already been submitted through the clearinghouse to health plans. Read More

Educational Programs

MiraMed has perfected the development of educational programs for providers and their staff that are multi-focused and include (but are not limited to) newsletters, coding-related eAnnouncements, one-on-one individualized learning, formal presentations, generalized topics and specialized topics, all of which are influential factors in improving documentation and reporting as well as improved auditing results by the medical group. Read More

Primary Care Physician Scorecards
MiraMed provides individual practitioners with ongoing progress reports and feedback scores based on HCC reporting per member within their panel as well as peer comparison rates. Read More

Member Outreach

MiraMed will develop a tailored internal program to do member outreach. This involves an active appointment tracking program as well as outreach based on on-going practitioner face-to-face visits yearly. Read More

Annual HCC Assessment Program
Yearly, face-to-face, annual HCC assessments by practitioners for the evaluation and medical management of patient chronic conditions play a significant role in the maintenance of quality clinical practices. MiraMed will facilitate the program entirely or implement the program so that the providers can manage the program internally. Read More

HCC Coding
Hierarchical Condition Categories, referred to as HCC, is a method of maximizing services to patients while receiving additional revenue to cover such services. HCC incorporates clinical documentation, coding, auditing and reimbursement.  Leaving a diagnosis under documented, not substantiated, or not coded could result in loss of thousands of dollars per patient. When implemented correctly the benefits impact the patient, the organization, and the healthcare community. Read More

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