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Physician Record Reviews

AdvantmedPhysician 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.

Key Advantages:

  • Identifies care opportunities in accordance with clinical guidelines
  • Relies on board-certified physicians in their area of specialty with extensive risk adjustment training to uncover the potential for risk-adjusting conditions not identified by current programs.
  • Opportunities to focus on HCCs within each patient chart, annotating risk adjustable conditions by page number, and integrating outputs into a broader array of activities.

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.

Learn more about our solutions today

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