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A 10 Step Plan to Successfully Implement Medical Risk Adjustment

03 Mar, 20235:05 PM

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A 10 Step Plan to Successfully Implement Medical Risk Adjustment

Medical Risk Adjustment is a concept that has begun to see the light of day now that the healthcare paradigm is rapidly moving towards value-based reimbursement schemes and a greater emphasis is on outpatients. Read on to get a better understanding of MRA and how to succeed with it.

MRA, a practice that helps standardize healthcare, is revolutionizing the way medical services have been traditionally gauged. It entails processes that make it possible to measure every health care service on similar terms – the severity of illness, the intensity of intervention, goals accomplished, customer service, compliance, and utilization management. MRA encompasses methods to improve the quality of clinical documentation, the accuracy of coding and billing, and customer satisfaction. It also loops in utilization management as access to clean data, and a plan to periodically review, analyze, and report it has become increasingly important when it comes to spotting inefficiencies and eliminating them. All these intricate mechanisms are vital if you wish to build a reputation of being an entity that has a much lower risk of adverse health outcomes.

key benefits

Here is a 10 Step Roadmap that will help any healthcare facility succeed in establishing MRA:


  1. Training – A training plan that ensures constant knowledge dissemination concerning all aspects of MRA and targets providers (including specialists), administrative staff, auditors, coders, and billing teams is a perfect start.

  2. Partnerships – Building connections with other stakeholders who are integral to the healthcare continuum is necessary to improve results. Medical specialists, insurance providers, medical data analysts, and care managers are some of those who need to be looped into your MRA plan.

  3. Frequent Checks – Building a system to continually check patient charts and the codes assigned to various services to detect anomalies and correct them in time or learn from them is vital to cut risk.

  4. Compliance Training – Ensuring that all your employees attend compliance training at least once a year and are also certified in this subject annually is a good idea when it comes to running a fully compliant organization.

  5. Automation – Invest in a utilization management software that helps keep all patient data together and helps make it actionable. It is this system that should act as a central point for all services rendered to your patients inside and outside your organization.

  6. Smart Database – A data collection and storage system that allows you to update patient records instantly can be a useful tool to support an accurate diagnosis. Hospital records, discharge summaries, consults, lab reports, and many more similar data points can be captured and stored for future reference.

  7. Incentive plan – Offering incentives to those physicians who work towards quality enhancement and champion compliance will help keep them motivated as well as encourage new ones to join in.

  8. Customer Service – Focusing on improving customer service to provide a better patient experience can help you retain them for longer.

  9. Speciality Services – Developing customized plans for patients with special needs and setting up speciality clinics can help mitigate risk.

  10. Feedback – Seeking MRA related input including MRA scores for your organization can help you in proactively modifying systems and processes.

key benefits

All efforts in the direction of achieving perfect MRA scores are building blocks for developing an airtight compliance program – a step that cannot be avoided for long in today’s era of escalating health care costs and diminishing revenues.

Contact Mirra Healthcare (TPA) today to get access to the products and services included in their Medicare in a Box solutions.

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NANCY GAREAUCEO of Ultimate Health Plans

"In 2021, Ultimate Health Plans (UHP) partnered with Mirra Health Care (Mirra) to develop a software platform to support processing Claims, Customer Service, Eligibility, Enrollment, Premium Billing, Encounter Processing and a Provider Portal for our Medicare Advantage Plans. Mirra collaborated well with our operations and compliance teams to successfully design and implement a system that was innovative, efficient, and compliant with all Medicare and Florida Medicaid guidelines and requirements all within the scope of our required timeline. We greatly benefitted from the Mirra Project Management Team’s regular communication with Stakeholders through monthly meetings and recurring weekly breakout-focused calls, which were geared towards troubleshooting and goal alignment. Mirra was able to quickly maneuver and adapt their systems to our needs, resulting in successful implementation and go-live. Mirra continues to support our compliant operation and growth in the ever-changing healthcare industry rapidly and effectively updating their systems with new Medicare and Florida Medicaid rates and guidelines to ensure seamless compliance and efficiency. I have absolutely no reservation in recommending their systems to any Payer searching for improvement in their operational efficiency."

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