Why Encounter Data is More Important Than Ever

Posted by Darryl Low on Apr 18, 2019 11:19:38 AM

iStock-924365076-webeEarlier this month, the Center for Medicare & Medicaid Services announced that they will be calculating 2020 risk scores by adding 50% of the risk score using diagnoses from encounter data (supplemented with diagnoses from RAPS inpatient data) and FFS data and 50% of the risk score calculated (using the 2017 CMS-HCC model) using RAPS and FFS diagnoses. This doubles the current percentage of encounter-based risk scores used for the final calculation, meaning every encounter reported up stream will soon be more important than ever.

Fortunately, CMS (and health plans) continue to improve and refine their Encounter Data Reporting system to provide greater transparency into both quality and rejection reporting. The 277-CA and MAO-02 response files are key to this transparency and fortunately have become standard in the encounter data submission process.

Citra’s EZ-EDI solution, part of the EZ-Suite, provides our clients with the ability to consume 277-CA and MAO-02 response files and easily identify, correct and resubmit rejected encounters. As part of our commitment to continuous product enrichment and through close collaboration with partners within our client base, you can expect even greater enrichment of EZ-EDI’s encounter data submission solution, which will further simplify your encounter data submission and clean-up processes.

If you are not familiar with this great feature, I encourage clients to reach out to your Client Success Manager to arrange a personalized demo for you and your organization. If you are new to Citra's products and services, please email info@citrahealth.com for a discovery meeting with our team. 


Topics: technology

Darryl Low

Written by Darryl Low

Darryl joined the Citra Team with an intimate understanding of the Value-Based Care market and a long history with the EZ-CAP product suite. Darryl’s 25 years of experience in health care includes extensive leadership roles in managed care organizations, coordinated care vendors, and as a past President of MZI Health Care providing Citra with a great depth and breadth of knowledge which will be leveraged throughout the organization in support of our growth objectives. In his role as Vice President, Market Strategy, Darryl provides strategic advice to the Executive Management Team to achieve and expand the goals and objectives of the organization. His primary responsibility is to ensure our priorities are executed upon and will work closely with team members across the organization to ensure this objective is completed.

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