PHYSICIAN RECORD REVIEWS
Physician Record Review (PRR) performs two-stage retrospective chart reviews with 1) a certified coder and 2) a board-certified physician. This empowers Medicare Advantage (MA) plans with clinical insight into risk-adjusting conditions to enhance traditional analytical platforms.
The solution also provides notes for primary care, specialists’ hospital charts, radiology and laboratory results not routinely used in standard analytics to provide more demonstrable actionable information.
PRRs confirm the previous two years of submitted HCCs for clinical confirmation not currently submitted in the calendar year, providing a more complete picture for the risk adjustment factor, increasing the accuracy of the patient’s risk score and, ideally, creating clean claims and faster reimbursements.