# Medicare Risk Adj. Review?



## skm510@live.com (Oct 22, 2012)

Two of the doc's in our practice have been selected to submit records for this... the notice states the purpose is to capture proper ICD-9 coding.  Just wondering if anyone else has experienced one of these? and if anyone has any tips or advice as to preperation etc...


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## skm510@live.com (Oct 23, 2012)

Still hoping someone might have some insight on this topic... another question I have regarding these type of reviews is: They are only requesting data from 1/1/11 till present would it be a good idea to make charts containing only documents for that time frame? Pull the documentation for that required time frame and make packets for them? or just hand over charts... Some in the office feel we only have to provide documentation for time frame requested?  but we do not want to look like we are hiding anything.  The reasoning behind only supplying the reviewer with the exact info. is that we then in return know exactly what info the have to review.  Also, another person claims we do not have to allow them in the office? Letter clearly states we must provide a well light environment.  Any advice would be greatly appreciated.


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## Evelyn Kim (Oct 23, 2012)

Is the request coming from a Medicare Advantage plan?  If so review the contract regarding reviews.  As a general rule MA plans are required by CMS to do an audit of all the members records.  This is to gather the necessary information for the MA plan to submit to CMS to establish the risk adjustment for each member.  The time frame is limited to the previous calendar year, so 1/1/11 would be accurate since the MA plan can submit 2011 codes through the end of 2012.  They are only going to reveiw the dates of service requested so even if you provide the whole chart for them they will only look at the specified time frame.  It is not necessary to make separate charts for this type of review, since they will only be looking at the specific time frame.  As for letting them in the office, again look at the contract, you will probably find that you are required to let them in.

Hope this helps


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## skm510@live.com (Oct 24, 2012)

Thank you Evelyn! That was very helpful!!


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