From Health IT Answers (formerly RCM Answers) — 1/27/2020:

Government-Supported Health Plans Must Make Encounter Submissions a Top Priority in 2020

  • Encounter data — such as diagnosed clinical conditions and services, or items delivered to healthcare consumers to treat these conditions — is the key to success for all healthcare organizations participating in the government space.

  • Whether doctors or hospitals are submitting data for medical services rendered under Medicare Advantage, the Affordable Care Act’s state exchanges or Medicaid, encounter data is used for payment reimbursement and reconciliation between the health plan and the government entity.

  • Each line of business has its requirements on how encounter data should be generated for the government agency to calculate the payment. And each government entity also has its own methodology on how it will use the encounter data to reimburse the health plan.

  • Additionally, health plans that participate in state Medicaid have their own rules for generating electronic healthcare claims (837 files) and reconciliation with various response files.

  • Health plans must be nimble and adapt to changes quickly to ensure they submit correct, complete and accurate transactions within the mandated timelines or risk penalty and impact to their bottom line.

To read the full article, click here.

Key Takeaway

The complexity of managing and monitoring a wide range of regulations to ensure compliance and accurate reimbursement often results in a subpar process. From dealing with multiple third-party vendors to haggling for the IT department’s support time to manually collecting incomplete data for reports that serve as the foundation for improving patient health and health plan business, this massive coordination effort means a lot of time spent that can result in very little quality and revenue.

With Babel Health, you are supported by:

Experts who know the latest changes to industry requirements; and

An all-in-one platform that helps to improve data accuracy and maximize revenue.

Our technology pre-validates 100% of your encounter data, alerting you to errors prior to submission — before they turn into revenue loss. And with this one-of-a-kind tool, you have the power to quickly and easily submit accurate, complete and compliant encounter information. We have always made encounters submissions the priority.