If your organization participates in Medicare Risk Adjustment (MRA) audits, you may notice them sooner than normal this year.  These reviews are critical for insurance payers analyzing their patient pool and forecasting risk for the future.  The expert Reviews team at ScanSTAT is reporting that UnitedHealthcare is approving MRA audits a full two months earlier than what is typically expected.  “While normally UnitedHealthcare MRA reviews are approved in August, we’re seeing them approved in June this year,” reports Cathy Smith, Review Specialist for ScanSTAT.  “This is significant for healthcare organizations because MRA reviews are sizable.  While HEDIS reviews may consist of a few charts for a review, most MRA reviews are in the hundreds or even thousands.”

MRA reviews also differ from HEDIS reviews in another key respect: while HEDIS looks at specific gap measures and more narrow data over the course of several years, MRA reviews are greater in data size, looking at the entire health of an individual over the course of approximately a single year.  Larger amounts of data requested means more time staff need to pull, verify, and audit the information to go to the designated payer, resulting in lost patient-facing time and a delay in performing other critical tasks for the practice.  “The population pool of these audits is sizable,” says Jody Kramer, Director of Release of Information.  “These MRA reviews create a huge time deficit and distraction for healthcare practice staff, yet they are still something that the office needs to get done, someway, somehow.”

Like other audits, the contract between a healthcare organization and the payer provides the agreement of what types of reviews are to be performed, and in what way.  Contracts between insurance payer and practice often include a component of reviews because payers want to ensure they are appropriately containing their risk and they are reimbursing quality care appropriately.  Failure to properly expeditiously execute a review could mean declining reimbursement for the healthcare practice, or even the termination of a payer contract.  

If you find yourself with a large MRA audit, know that ScanSTAT can help.  As experts in health information management, we provide the speed and efficiency to handle these necessary reviews without taking your staff away from where they are most impactful – patient care.  Want more information? Check out our FAQ on Reviews or our webinar on how to handle review season.  Ready to release reviews for good? Contact us today to learn more about releasing the burden of reviews to ScanSTAT.  

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