Practice Management

 View Only
  • 1.  MEDICARE RISK AUDIT REVIEWS

    Posted 05-22-2023 18:11
    We are getting hammered by Advantage plans asking for records for "Medicare risk adjustment reviews"
    I just got one from Aetna asking for records on 30 patients and giving me 10 days to 'comply'
    They are asking for all records (face sheets, orders, reports, clinical notes) from 01-01-2022 to present on all these patients. 
    It states 'this is not a claims payment audit but a medical record audit" 
    It is a 3rd party company working on behalf of these Advantage plans and they are telling us we have to provide the records at no charge to them.

    Is this correct? Do we have to submit all these records to them at no cost for medical records?




    RESPECTFULLY, 

    Rick D Gladish, RCC, CPC
    MD Revenue Management, LLC
    111 Troy St STE F
    Tupelo, MS 38804
    ph 662-620-7102 fax 662-620-7106
    email: rick@mdrm.us
    website: www.mdrm.us

    ==== The information contained in this message is intended only for the use of the named recipients unless otherwise stated. If you are not the intended recipient, please notify the sender of the error and remove the message from your computer. This message may contain personal views which are not the views of MD Revenue Management unless specifically authorized. The integrity and security of this message cannot be guaranteed and it may be subject to data corruption, interception and unauthorized amendment, for which we accept no liability. ====


  • 2.  RE: MEDICARE RISK AUDIT REVIEWS

    Posted 05-23-2023 08:56

    Your obligation for this sort of thing is usually addressed in the contract.

     

     

           David Smith, FACMPE  |  Executive Director  |  913.444.9359

    5800 Foxridge Dr.  Ste 240  |  Mission, KS  66202  |  www.uickc.com

    p-uic-horizontal-03a

     

                                                              Member of