Risk Adjustment/HCC Best Practices

The Best plan; the Best practice. Simply put, the best practice includes provider education, chart auditing, queries and follow-up. MARSI has continuously audited many plans and provider groups and has first-hand knowledge of what works and what doesn’t.

It is not surprising that the provider group with the lowest overcode rate and the highest RAF scores actually started a process almost identical to MARSI’s three years before they asked MARSI to audit them. MARSI’s best practice includes:

  • A Snapshot Audit- a good estimate of the magnitude of the problem
  • Physician to Physician Education- it’s not enough for significant change
  • Audit All Charts- that are likely to have error
  • Query the Providers- find the problems and continuously retrain
  • Follow-Up on Queries – compliance, quality and accuracy
  • Start Over- until there is manageable error


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