MRA

Medicare Risk Adjustment (MRA) is the system CMS uses to determine appropriate reimbursement based on the health status and complexity of a patient population. Under this model, providers caring for sicker, higher-need patients should be compensated accordingly, but only if that complexity is accurately documented and coded. MCM ACO’s MRA program helps providers capture the full, true picture of their patients’ health, ensuring fair and appropriate reimbursement.

Accurate risk adjustment isn’t just an administrative exercise, it directly affects a practice’s ability to sustain the resources needed to care for complex, high-need patients. Under-documentation can lead to underpayment, while inconsistent or inaccurate coding can create compliance risk. Our program is built to avoid both, helping providers code confidently, completely, and correctly.

A central part of our approach is supporting thorough Annual Wellness Visits and pre-visit planning, giving physicians the information they need to review a patient’s full condition history and ensure nothing is missed during the encounter. We also conduct chart reviews and coding audits to catch documentation gaps, identify conditions that may have gone unreported, and correct errors before they affect risk scores.

By strengthening the accuracy of risk adjustment data, MCM ACO helps ensure providers are properly resourced to care for the patients who need the most support, while maintaining full compliance with CMS documentation standards.