Retrospective Chart Auditing

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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.

 

Services included:

 

  • Review dates of service within the current year, improving outreach potential of members prior to completion of each reporting year.
  • Avenue for reviewing documentation and data from previous risk adjustment reporting years prior to final closure date deadlines by CMS.
  • Specialized focused audits for selected populations of patients and/or specific HCC categories prior to sweep dates.
  • Ongoing educational opportunities for primary care physician (PCP) and staff based on findings within retrospective audits.
  • Validate functions for diagnostic codes previously submitted by providers.
  • Upon request, submit code corrections forward (additions and deletions) to health plans upon completion of review.



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