Medicare Risk Adjustment (MRA)

For over fifteen years, BRG Healthcare has been a trusted advisor to clients on compliance, litigation, and enforcement risks, as well as issues in the risk adjustment area. Our clients encompass Medicare Advantage Organizations (MAOs), large provider groups and management services organizations, private equity firms, healthcare technology vendors, and law firms. Our team includes former health plan executives, certified risk adjustment coders, clinicians, data analysts, and seasoned litigation consultants. Our engagements have included risk adjustment operational and compliance assessments, government and internal investigation support, self-disclosures, and privileged litigation consulting. We understand the current government focuses on the accuracy of risk adjustment submissions and the scrutiny that government regulators and enforcement agencies put on certain risk adjustment programs, policies, and procedures. We have helped our clients assess, understand, and adapt to these risks to ensure compliant practices. 

Our experts: 

• understand risk-sharing arrangements, reasonable performance benchmarks, and MRA program and process guideposts 
• appreciate the nuances and importance of diagnosis coding and compliant medical record documentation 
• are familiar with the Centers for Medicare and Medicaid Services (CMS) encounter data submission process 
• are proficient at analyzing data, including enrollment, diagnoses submissions, and risk scores using CMS MRA data sets, such as Risk Adjustment Processing System files, MAO-004 and MAO-002 Encounter Data Processing System files, monthly membership reports, and Model Output Reports