On October 8th, GHG’s SVP of Healthcare Analytics and Risk Adjustment Solutions, Jeff De Los Reyes, moderated a webinar with Austin Bostock of Pareto Intelligence and Meleah Bridgeford of Episource to discuss the future of the regulatory environment, as well as steps you can take to ensure that your data is ready in advance of the submission deadline.
Our speakers shared their unique perspectives on the best strategies to deploy to ensure that your upstream encounter data is accurate, complete, compliant, and ready for submission.
If you did not get a chance to attend the webinar, click here to view the recording.
Some of the key questions answered in this discussion include:
- What are the major impacts from CMS’ 2022 Advance Notice on the current regulatory environment? CMS is projecting the risk score impact of transitioning to the 2020 HCC risk adjustment model to be 0.25%. While the impact on MA risk scores being calculated using 100% encounter data is projected to have a neutral impact at 0.00%, the shift to EDS is very much driven by the complexities of the process, and our experience shows the impact could be between a 1-3% difference between EDS versus RAPS. – Jeff De Los Reyes, GHG
- What are the potential risks for either revenue exposure or compliance exposure as plans move from RAPS to EDS? To avoid the risk of compliance exposure, it’s important to not only look for incremental revenue, but to also take a bi-directional look at both adds and deletes to ensure the data is complete and accurate. When it comes to revenue exposure, we’ve found that data leakage can lead to suppressed risk scores and result in an average of $35-$50 PMPY impact for both the MA and ACA markets. – Austin Bostock, Pareto Intelligence
- How can plans proactively prepare to mitigate the undue burden that EDS can cause? One way to manage this process is by tracking encounters through the entire submission process (i.e., tracking the recipient of the claim from CMS all the way back to your EDW). Another major factor is timing. Many plans currently submit RAPS on a near-monthly basis, but it’s going to be critical to submit EDS just as frequently, if not more frequently than RAPS. – Austin Bostock, Pareto Intelligence
- With front-end submissions being so complex, how can plans evaluate their readiness for remediating back-end EDS errors? The key to being successful with EDS is knowing your data. Plans must be able to identify where data leakage is most likely to occur, whether it be from receiving incomplete data from providers or potential errors with internal system processes. Conducting a RAPS/EDS revenue audit or an EDS gap analysis can identify these top errors and help plans prioritize remediation efforts. – Meleah Bridgeford, Episource
Watch the Webinar on Demand!
The answers to these questions and many more are discussed at length in our October 8th webinar titled, “Strategies to Ensure Accurate Coding and Submission of Upstream Encounter Data.” Use the form below to receive access to a recording of the webinar and explore the various insights from the panelists.
Where Do We Go from Here?
GHG, Pareto Intelligence, and Epsiource have collective experience in working with payers and providers in MA, ACA, and Medicaid to ensure accuracy and compliance with risk adjustment programs. Given the increased emphasis on the EDS submission model and the growing potential for revenue shortfall, MAOs should begin assessing encounter data now to resolve issues in advance of submission deadlines. Contact us today to start the conversation.