Empirical Risk Management

Phone: 772-210-2823

Fax: 772-210-2824

Kameron Gifford, CPC

772-267-9453

Todd Gifford, MBA

772-267-8156

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MRA Alert

Empirical Risk Management has identified a methodology to improve the quality of care while focusing on compliance to positively affect change within a managed care population.

• Education and Training to Providers and Patients
• Auditing and Compliance in accordance to OIG Standards
• Implementation and Monitoring of Initial Health Assessments and Annual Preventive Services
• HEDIS and Star Improvement Programs

Provider Education

Provider Education will be comprehensive utilizing multiple methods of instruction.

Annual Education

Annual education and training will be organized to meet CMS standards. These will include annual HIPPA and compliance training for all downstream and related entities.

Quarterly Education Meetings

Quarterly education meetings will be organized for all physicians with topics to include MRA, HCC documentation and coding, and compliance standards. Quarterly meetings will include a presentation and educational handouts to assist providers in current correct coding and documentation standards.

Individual Education

Empirical Risk Management will develop specialized educational opportunities targeted towards individual deficiencies indentified in medical record review. The specific needs of providers will be addressed to correct and prevent future errors.

Electronic Monthly Newsletters

Monthly newsletters will be distributed to all providers highlighting specific areas of interest in coding, documentation, compliance, and education.

Patient Education

Patient education is essential to quality improvement efforts. Classes will be developed to meet the unique needs of each member population. Providers will be notified of available classes and members will be invited to participate. Available topics include: Controlling Diabetes, InsulinTraining, Medication Compliance, Care Planning, and Smoking Cessation.

Initial Health Assessments

Annual health assessments will be developed to include all required elements of the Medicare Initial and Annual Wellness exams. The assessments will be conducted by the Primary Care physician who each member is assigned. The assessments will be submitted annually as an encounter and appropriate documentation will be forwarded to the plan. All HCC diagnoses captured within the last 12 months will be available for the PCP’s review prior to the patient’s exam.

HEDIS and STAR Improvement Efforts

Measuring health care performance is critical for managed care organizations to evaluate the level of service their providers deliver, identify performance gaps and make any needed changes to cultivate continued member satisfaction and loyalty. HEDIS and STAR ratings were considered in great detail throughout the development of our methodology. Every aspect of our process works to enhance both measures. Our HEDIS review covers 74 measures across 8 domains. Score cards are provided for each measure identified.

A Complete Solution

Empirical Risk Management understands what managed care organizations and physicians need, and we can provide the process and expertise that will deliver results.

Health Fair Provides Information on Diabetes

Posted: Jun 21, 2012 6:07 PM CDTUpdated: Jun 21, 2012 6:07 PM

CDTCORPUS CHRISTI (Kiii News) -





A community health fair turned the spotlight on diabetes and its causes Thursday."The focus is diet, alcohol avoidance, tobacco avoidance and exercise," said Todd  Gifford, managing director of MCCI of Texas.Hundreds of people showed up to the Ortiz Center Thursday morning for the MCCIHumana Health Fair. Participants were able to get free health screenings like bloodpressure and sugar level checks, diabetic ulcer checks and most importantly, informationabout prevention."Once we know our levels, we can eat better and exercise more, and elevate levels to ahealthy norm," participant Norma Guerrero said. "If we don't, we end up getting sick, andwe take more medication, end up in hospital with a stroke or heart attack."Currently one-in-four Texas senior citizens has type two diabetes