MRO Viewpoints
HEDIS Preparation Guide: 3 Essential Steps
HEDIS (Healthcare Effectiveness Data and Information Set) is a critical quality measurement tool used to assess healthcare performance across various domains. For healthcare organizations, the HEDIS season, which typically spans February to May, requires a proactive...
Navigating QPP Reporting in 2025: Finding the Best Path for Your ACO
Mandatory Alternative Payment Model Performance Pathway (APP) reporting begins this year, bringing significant changes for Accountable Care Organizations (ACOs). As we move into this new reporting era, the question isn’t whether to act but how to act effectively....
What Payers Need to Know to Stay Ahead in 2025
2025 has arrived and with it brings new challenges and potential opportunities to the healthcare landscape. Payers face increasing regulatory demands, heightened expectations for interoperability, a renewed focus on payment integrity, and rising pressure to address...
Why Investing in Internal Auditing Tools is Key to Reducing Coding Risks and Financial Losses
As the healthcare industry faces increased scrutiny, especially in medical coding accuracy and regulatory compliance, recent surveys reveal that many professionals are concerned with issues like upcoding, audit discrepancies, and the integration of artificial...
MRO is Advancing Quality Control Solutions for Release of Information
At MRO, we are continuously improving quality control standards by introducing additional safeguards for sensitive information. These additional safeguards allow us to flag sensitive information during the quality control process, helping your organization meet...
Navigating the CMS 2025 Physician Fee Schedule Final Rule
The Centers for Medicare & Medicaid Services (CMS) 2025 Physician Fee Schedule (PFS) Final Rule brings notable updates to the Quality Payment Program (QPP), which will impact eligible clinicians, groups, virtual groups, subgroups, and APM entities. Whether you’re...
What is HEDIS? The Basics, Objectives and Significance
One of the most important tools utilized by payers across the country is the Health Effectiveness Data and Information Set (HEDIS), which is maintained by the National Committee for Quality Assurance (NCQA). HEDIS is a measurement set used to determine the efficacy of...
Why Your Final MIPS Score Might Be Different from What You Expected – and What You Can Do About It
If you’re participating in the Merit-based Incentive Payment System (MIPS) or MIPS Value Pathways (MVPs), you’ve likely encountered a familiar scenario: you review your estimated MIPS score in your dashboard, only to find that months later, when CMS releases the final...
Modern Efficiencies for a Modern Audit Team: MRO Experts Share How to Reduce Risk
Internal audits and monitoring are essential practices to ensure coding and billing compliance, protect revenue, and defend against payer audits and clinical denials. However, with limited time and resources, it becomes impossible to internally review every physician,...
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