Payer Audit & Review Support
Ensure payers receive only the data they are entitled to, while assuring your health system minimizes any additional cost burden and optimizes privacy and compliance.
We understand that payer record requests can be challenging, especially during time-sensitive periods for risk adjustment and HEDIS reporting. At the same time, shifts in payer contracting models and relationships may be driving payers to dive more deeply into your EMR for clinical information without consideration for compliance, privacy and disclosure requirements.
As a result of our national footprint, we work proactively and collaboratively with payers and their third-party vendors to create processes and leverage technology to manage large-scale, high-volume and time-sensitive request lists. MRO’s National Service Center handles high-volume payer review requests. Clients do not feel the burden of logging requests because with batch logging through our ROI Online technology, thousands of requests are verified in minutes. Deep ROI expertise is applied to each audit request, ensuring authorizations are HIPAA compliant.
Our Payer Relations team will evaluate the payer record requirements, review existing managed care contracts, negotiate project deadlines and ensure records are released according to your disclosure standards. In addition, we can provide recommended language and terms to negotiate into your managed care contracts to limit open access to PHI by payers and reduce the financial burden. We work directly with payers on your behalf, focused on protecting and strengthening the payer-provider relationship by fulfilling timely, accurate and secure Release of Information (ROI) requests, limited to the intended purpose of use.
Finding Civility in Payer Relationships – Audits, Reviews & Health Information Management
Defend Against the Rising Tide of Government and Commercial Payer Audits
Audit Compliance Services
MRO designates payer audit requests with priority status to be handled by a dedicated audit team. All audit requests are routed through our quality Release of Information (ROI) workflow. By selecting the most appropriate delivery method for each audit request, like using electronic delivery whenever possible, costs are reduced.
As a certified Health Information Handler (HIH), MRO interfaces with the Centers for Medicare & Medicaid Services (CMS) Electronic Submission of Medical Documentation (esMD) gateway.
Centralized Supplemental Review Services
MRO’s National Service Center handles high-volume payer review requests. Clients do not feel the burden of logging requests because with batch logging through our ROI Online technology, thousands of requests are verified in minutes. Deep ROI expertise is applied to each audit request, ensuring authorizations are HIPAA compliant.
Managed Care Contract Services
The team analyzes client ROI data, reviews managed care agreement terms and provides tools to equip clients to negotiate language and terms that protect them from undue burden regarding medical record requests.
3 Reasons Clients use MRO’s Payer Audit and Review Support
- Complimentary service. All MRO clients receive the value-added audit compliance services to help reduce or eliminate the workload associated with government or commercial payer audits and reviews.
- Ease of use. Clients’ day-to-day operations are not interrupted with massive audit and review requests.
- It is flexible. MRO manages the entire audit process, including correspondence and advanced processing, or only selected duties, depending on clients’ preferences.