CMS Updates on Full Encounter Data

Last Week, CMS posted an updated CMS Encounter Data Participant Guide. Also published was a presentation from the training sessions held by CMS in August and September.  It does not appear that the presentation was updated, although we do not know for sure. It still contains references to benchmarks for 60% submission within 60 days and 90% within 90 days.  We are still hoping that CMS will not hold us to these benchmarks.  However, Medical Groups and Hospital providers must be prepared for the possiblity that this may occur.

We will be posting these new documents on HCC University on the Full Encounter Data/ICD-10 page within the next 48 hours.

Looking for Links to CMS 5010 Edits?

You can find them in the menu to the right of this post, titled: Full Encounter Data Links.  In addition to the front end edits, you will see a link to TARSC, where information regarding the ongoing CMS/Health Plan calls.

If you have questions, or comments, please post a comment or send them to us at coding@scanhealthplan.com.

Do You Have Questions about CMS Full Encounter Data?

On Wednesday, we're having a Full Encounter Data webinar, to discuss the changes needed due to the CMS requirement that Health Plans begin submitted a full 837 v 5010 transaction for all encounter data, beginning 1/1/2012.

Do you have questions you'd like us to answer during the webinar?  If so, please send an email to coding@scanhealthplan.com with your question, or leave us a comment. We can't guarantee we'll have an answer, but we'll do everything we can to get the answers from CMS in the ongoing Health Plan/CMS meetings.

We have more information on our website at Full Encounter Data.

SCAN Hosts Full Encounter Data Webinar for our Provider Partners

Guest Blog Posting By Marc Carren, Encounter Data Manager

As you know,  on Friday, October 29,  2010, CMS held a Medicare Advantage industry-wide national meeting and formally announced their decision to transition from the current Risk Adjustment Processing System (RAPS) to a Full Encounter Data Collection model and a new CMS Encounter Data Processing System (EDPS).  This EDPS encounter data will be used to feed into CMS’ existing Risk Adjustment Processing System.  We sent an announcement to all of our provider partners, and asked that the announcement be shared with individuals within their organizations charged with:
¨       Supervision/management of claims and encounter data 
¨       The hands-on tasks of collecting the  encounter data from your service providers or sub-contracted providers ,
¨       The hands-on tasks of upgrading systems, operations, and work flow, and
¨       The responsibility for working with SCAN to ensure your organization can be in compliance with these high-impact CMS requirements by 1/2/2012.

On Wednesday, March 23, from 10a.m. to 11 a.m., SCAN will hold a Kickoff webinar conference to formally announce this initiative, our plan, and discuss any issues you expect with this transition.  If you know of anyone within your organization that needs to be involved in this webinar, and did not receive an invitation, please send an email to coding@scanhealthplan.com, and we'll  have someone contact you with Webinar information.

Following the kickoff webinar, SCAN will begin an assessment and survey effort via conference calls with all our Provider Partners.  The results of this assessment will inform our project plan and alert us to any possible assistance, guidance, or consultation various partners may require.  This initiative will be covered in more detail in the Kickoff webinar.
We thank you in advance for your attention, participation, and effort.
Sincerely,
Marc Carren
Encounter Data Manager
SCAN Health Plan

Next CMS Fee-for-Service 5010 Conference Call: March 30, 2011

On March 30, 2011, CMS will host the next conference call in their series on the transition to the ANSI 837 5010 transactions.  The topic of this call is Provider Testing and Readiness.

CMS will be posting additional information regarding the call on the CMS Website at: http://www.cms.gov/Versions5010andD0/V50/list.asp?listpage=2

You should check the CMS website two to three weeks before the call for Webinar and call in information.

New Documents Posted to the HCCUniversity.com

We have posted a number of new documents to the Full Encounter Data/ICD 10 page of HCCUniversity.com.  Scroll down to CMS Encounter Work-Groups and you'll see the documents listed below.

All of the documents are related to the January 2012 implementation of full encounter data, and the CMS workgroups that are ongoing.  Most of the questions are unanswered as of this time, but we hope as new documents become available, CMS will make more decisions.

Capitated and Staff Model Plans Summary Notes

Chart Review Work Group

Encounter Data Newsletter - Quarter 1

Encounter Data Newsletter –Quarter 2

Encounter Data Work Group Summary Notes for Editing and Reporting: Key Findings and Recommendations

Third Party Submitters Work Group

New CMS Full Encounter Data Document Posted to HCCUniversity.com

There is a new document related to the CMS Full Encounter Data workgroups that are ongoing. It has been posted on SCAN Health Plan : Full Encounter Data/ICD-10 .  The document is titled Encounter Data Workgroup Summary Notes for Editing and Reporting: Key Findings and Recommendations.




On January 12, 2011, there was a workgroup meeting regarding editing and reporting of full encounter data (i.e., 5010 transactions) required as of January 2012.  Note that all of these documents contain as many unanswered questions as answered ones.  We will provide updates as they become available.

New Full Encounter Data CMS Q&A Document Posted

Beginning in January 2012, we will be required to submit full encounter data for all services, using the ANSI 837v 5010 format, to CMS.  These data will be used for Risk Adjustment, quality initiatives as well as measuring healthcare utilization in MA plan members. Because of this, it is more important than ever that health plans and their providers work together to ensure that encounter data is complete and accurate. Basically, health plan data must follow the criteria of your fee-for-service Medicare claim submissions.

SCAN is committed to keeping our providers informed of all developments related to this CMS initiative.  We've created a special section on HCCUniversity.com dedicated to the 5010 transition, as well as the related implementation of ICD-10-CM in 2013.

We have just posted a new document released by CMS in that section:

CMS Full Encounter Data Q&As

More joint CMS/Health Plan meetings are planned related to this initiative.  We will continue to post information on HCC University, and share what we know in our monthly EHUG calls.

There are many unknowns at this point, and health plans continue to work with CMS to clarify requirements and raise concerns about the implementation.  However, CMS remains committed to moving forward on this requirement effective January 2012.

CMS Launches Get Ready 5010 Website

CMS has launched a new website, GetReady5010.org, to support providers in implementing the ANSI 837 5010 Claims transaction.

Starting January 11-13, CMS will begin a webinar series to support the transition. The webinars will feature speakers from CMS, provider and payer organizations, and will discuss:

1.  The current level of readiness and plans for testing
2.  How to prepare for testing
3.  Version 5010 basics for newcomers

HCCUniversity.com has a new webpage dedicated to the transitions to 5010 (full encounter data) and  ICD-10 transitions--Full Encounter Data and ICD-10 .

CMS Help for Providers

Did you know that CMS has email subscriptions for special topics?  You can sign up to receive email alerts for a number of specific or general topics at:  CMS Email Subscriptions.

Right now, two hot topics are the transition to the 5010 transaction for claims and encounters (required as of 1-1-2012) and ICD-10 Transition (required as of 10-1-2013).  CMS has published a number of informational articles for physicians, office staff, and vendors.  A few you might be interested in:

The ICD-10 Transition: An Introduction

Talking to Your Vendors About ICD-10 and Version 5010

Talking to Customers for Vendors

What topics would you like to see more about on HCC University?  Drop us a line at coding@scanhealthplan.com, or leave us a comment!