ENCOUNTER DATA VALIDATION (EDV)
The Balanced Budget Act of 1997 (BBA) requires:
1. State Medicaid agencies that contract with Medicaid MCOs to develop a State quality assessment and improvement strategy that is consistent with standards established by the
Department of Health and Human Services (Section 1932(c) (1) (B) of the Social Security Act).
2. The BBA also requires HHS to develop protocols for use in the performance of independent, external reviews of the quality and timeliness of, and access to, care and services provided to Medicaid beneficiaries by Medicaid MCOs and prepaid inpatient health plans (PIHPs).
Encounter data can be used to assess and improve quality of care, as well as monitor program integrity and determine capitation payment rates. However, in order for encounter data to effectively serve these purposes, encounter data must be complete and accurate.
1. States and CMS need accurate and complete encounter data to monitor and improve quality of managed care services, and improve healthcare outcomes
2. States are required to submit both FFS and encounter data to the Medicaid Statistical Information System (MSIS) to reflect Medicaid utilization paid for by federal funds
3. Most states use encounter data for setting capitation rates, yet may not be sure about the quality and completeness of that data.
Aqurate staff has over 10 years of experience in working with EDV projects. Our staff has thorough understanding of Medicaid encounter submission requirements and validation processes. In addition, we have certified coders who are not only experienced in ICD9 coding but also certified in ICD-10 coding. Our programmers and analysts have excellent experience in understanding the challenges that are generally involved in encounter data validation projects. Our experience working with Medicaid managed care organizations combined with our several years of HEDIS auditing experience would make us an ideal organization to partner with to conduct Encounter Data Validation project.
To learn more about Aqurate Health Data Management’s services, or to request a proposal please Contact Us