From Health IT Answers (formerly RCM Answers) — 10/16/2019:
MA Plans Need to Get Serious About CMS Rule Changes

  • Just because the MA industry is seeing great growth, does not mean all plans will be successful and profitable. Medicare Advantage comes with its own set of challenges and requires deep expertise in many different areas to ensure continued success — especially when it comes to data.

  • Today, health plans must send two file types (RAPS and EDPS) concurrently for payment reimbursements. But soon, the rules will change and plans will need to adjust to CMS’ ruling that over the next two years, one of the file types (RAPS) will be decommissioned and the other (EDPS) will be the sole source used for payment reimbursements.

  • This means health plans need to double down on their efforts to ensure their encounter data processing is fully functioning. Revenue integrity will rely only on encounter data, and health plans must send the data in a timely manner, and make sure encounter data is complete, accurate, and can be traced back to patients’ original medical chart documentation.

To read the full article, click here.

Key Takeaway
Encounter data submissions are the most critical — yet least understood — part of the RAPS/EDPS risk adjustment process. Even minor errors can cause you to miss critical deadlines, fail compliance and jeopardize payments. But the transition from RAPS to EDPS doesn’t have to be painful. Babel Health is solely focused on helping MA health plans to be ready for a 100% EDPS world, as well as maximize their financial benefits. As your partner, you receive unlimited 24/7 email support and a dedicated team of subject matter experts who are fluent in all things risk adjustment. We’re here to guide you through roadblocks and answer your questions, every step of the way.