Encounter Data Completeness Assessment & Improvement

QMetrics can help you improve encounter data completeness to ensure accurate reporting of services. Our extensive knowledge of managed care and the capitated market allows us to swiftly target areas of weakness and/or data leakage points. In the environment of value-based contracting, we keenly understand the importance of full data capture and data completeness monitoring. We extend an audit approach to evaluating, validating, and reconciling data from all points of entry and exit. Our team has worked in and with health plans, provider organizations, and hospitals.

We can assist with:

  • Identifying encounter data leakage points and implementing process improvements;
  • Evaluation of low per member per year (PMPY) ratios and contributing factors to low PMPY;
  • Reducing encounter rejection rates by submitting trading partners, both incoming and outgoing encounters;
  • Facilitation of rapid cycle improvements by targeting “low hanging fruit” improvements as well as systematic improvements;
  • Providing best practice tools and recommendations for monitoring and reconciling data streams; and
  • Providing technological and reporting assistance to areas that are potential barriers to efficient workflows.

Our approach is to extend the traditional rapid cycle process of fast iterative improvements by simultaneously implementing more long term and strategic interventions.

Contact us at: info@qmetrics.us for a complimentary consultation.

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