Don't change EMR or Templates for encounter data just yet!!!
Maria K Todd PhD MHA
Principal, Alacrity Healthcare, founder of Self Pay Ortho Referral Network - Care Coordination & Case Management for Self Pay Orthopaedic Surgery | Speaker, Consultant, Author of 23 best selling industry handbooks
Are you aware of what's on the horizon (2022) to submit claims for 3rd party reimbursement? Stop that groaning! I hear it from here!
WHAT: Before you get all comfy with current and new encounter documentation templates, understand that more complex (150+ REQUIRED data elements under EDS per encounter to CMS, whereas current RAPS requires only 5 data elements) will be required going forward.
EDS vs RAPS
The RAPS system involves only five necessary data elements (dates of service, provider type, diagnosis code and beneficiary Health Insurance Claim [HIC] number), while the EDS system utilizes all elements from the claims (i.e., HIPAA standard 5010 format 837).
WHY? A more comprehensive dataset enables CMS to perform advanced data analytics and improve the methodology to predict future medical expenditures. It will always trail actual utilization, innovation, and changes in best clinical practices, so the frustration will NEVER end for us early adopters. Changes in payment models and rates must be submitted 2 years in advance to most Departments of Insurance, so 2-3 year old data and trends will still be used to set rates for two years forward.
What that means for providers: Expanded data sets means that we will need to invest additional capital and operating expenses to develop and maintain an infrastructure that can provide required data processing capabilities.
In addition, the technology platforms will need to include data filtering logic to identify records that are likely or unlikely to get accepted by CMS for risk adjustment.
The silver lining: We'll have better insights even with deidentified data for marketing and persona building, if you are ready and willing to use it for business development.
This change translates to more powerful, data driven decisions for technology purchases, recruitment of talent, media buys, SEO/SEM/PPC if you plan to use those things, and deciding targeted addressable markets for medical practices, ASCs, hospitals, and ancillary services provider collaboration. It will put your business development on rails! Less waste; better results!
Now, if I could only convince you all as to why recording the patients' current employer data in your patient registration is so necessary for your contracting strategy, I would leave this Earth a happy and content woman!
Let's talk about this if you want. I'm here if you need answers or clarification.
Maria Todd, PhD MHA
PH | 800 727 4160