maximizing medicare advantage payments

Maximizing Medicare Advantage Payments with MRA Calculators

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As healthcare providers and Medicare Advantage (MA) plans look to provide better care to beneficiaries, they are continually looking for ways to make better use of their financial resources to maximize their own returns while also freeing up more budget for their members. One way to achieve this is through Medicare Risk Adjustment (MRA) calculations.

Read on as we look at how MRA calculators can help maximize MA payments and allow providers to ensure a better service for their members.

A Guide to Medicare Risk Adjustment

Medicare Risk Adjustment is a payment model used to increase or decrease payments to MA plans according to the health of those enrolled. This model uses a risk score to adjust payments based on the expected cost of caring for their beneficiaries.

To do this, the MRA model takes into account demographic and clinical data, including age, sex, diagnoses, and other health-related factors, to determine the beneficiary’s risk score. The higher the risk score, the higher the payment to the MA plan.

Why Use MRA Calculators?

MRA calculators like the Medicare Risk Adjustment calculator are used by healthcare analysts and auditors from healthcare providers and MA plans to estimate risk scores and payments for individual beneficiaries so they can accurately assess the expected cost of caring for each beneficiary and adjust their care plan accordingly.

Maximizing MA Payments with MRA Calculators

MRA calculators can help healthcare providers and MA plans to fine-tune their payments by accurately assessing the expected cost of caring for their beneficiaries. By helping providers identify high-risk patients who require additional care and resources, such as those with chronic conditions like diabetes or heart disease, providers can then develop personalized care plans that address the patient’s specific health needs.

This not only helps to improve their members’ health outcomes, which results in more stable MA payments, but also reduces the overall cost of their care. MRA calculators can also help MA plans optimize their payments, allowing them to better allocate their resources. This ultimately allows providers to deliver a higher quality of care overall.

How MRA Can Improve Patient Care

While MRA calculators are good for healthcare providers, they can also help their members too. These calculators can be used to identify patients who are currently under-diagnosed or under-treated, which not only improves the health of patients but also helps providers deliver better service, but also helps to increase MA payments.

For example, if a patient has a health problem that has not been previously diagnosed, an MRA calculator can help detect it and ensure that the patient receives the appropriate care and treatment for their needs. It also means they are able to make payments for longer at the same time.

By using MRA calculators, providers and MA plans can accurately assess the expected cost of caring for each beneficiary and optimize their payments accordingly. By giving providers the ability to identify high-risk patients and under-diagnosed or under-treated patients, these calculators can help improve the service of providers and their resource allocation, ultimately benefiting both providers and their members.