Risk Adjustment

Still struggling with Encounter Data Errors? Read this

Never has there been a more critical time for health plans to be on top of Medicare Advantage encounter data. The last call for 2015 and 2016 MA submissions is right around the corner – August and September of this year, respectively.

CMS just issued its advance notice for 2019, which unveiled a rise in MA payments and adjustments from risk scores, together totaling increases as high as 6.5%. CMS also announced yet another change in the balance of encounter data vs. fee-for-service data from 15%/85% to 25%/75% and added more conditions to the risk adjustment model.

Clean your errors now

If just reading that list overwhelms you, trust us, you are not alone. The changes that have been swirling around CMS and its amped-up use of encounter data have left many financial teams spinning. And while it’s not an easy time to be a CFO or risk specialist, opportunities abound to use this data to improve visibility into your own plan’s fiscal health, to boost predictability of payments for your bottom- and top-line revenue, and to clean up errors that likely have been clogging your system and consuming team resources.

That’s where we come in. Since 2000, Episource has been helping health plans manage their risk adjustment and quality programs. We have made it our life’s work to innovate and optimize your data processes and increase the efficiency of your workflow overall. Over the years, we’ve strengthened our expertise in all aspects of encounter data, including collection, chart auditing (straight through to the provider), encounter data error correction, RAPS/EDPS reconciliation, and CMS mandates and compliance. Our knowledge complements our best-in-class technology platform, it’s human expertise that we put to use every day to guide our customers through these tricky times.

Why this blog

In this blog, we will help you get ahead of industry deadlines, such as the impending 2015 and 2016 MA submissions, and figure out processes that best serve your organization’s needs. Encounter data is not one size fits all, however CMS’s deadlines and expectations apply to all. We will help you tackle some of the biggest challenges surrounding these rules, including efficiently converting data from the Risk Adjustment Processing System (RAPS) to the Encounter Data Processing System (EDPS aka 837).

Not Just an IT Function!

Perhaps most importantly, we will give you the tools and knowhow to helm this important mission. There is a tendency to think that because technology (software as a service) is at the core of encounter data, then it should be looked at as an IT function. Nothing could be further from the truth. While you will need IT at the table to ensure proper integration with other systems, the financial team must have a firm hand on the wheel of encounter projects. We will show you how to lead in both processes and technology enhancements.

We are self-professed and proud encounter data nerds here at Episource. We look forward to sharing our insight with you to make your plan the most successful it can be in this very complex environment. So stay tuned!




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