Encounter Data Completeness

The evolution to innovative value-based contracting continues to reinforce the importance and value of complete encounter data.  Successful organizations need to continually assess and evaluate encounter data completeness to facilitate the implementation of effective solutions for maximizing data completeness and value. Most capitated payers, MSO’s, and provider groups report incomplete encounter data due to coding, technical electronic medical record (EMR) challenges, and variant health plan data submission requirements that may be further enhanced by complex and uncoordinated value based contract and incentive rules.  These incomplete data lead to numerous adverse outcomes, including:

We can assist with:

  • Reduced Medicare Advantage payments
  • Lower HEDIS® and quality measure rates
  • Lower STARS ratings and payments
  • Reduced AMP payments
  • Lower Medicaid premiums
  • Lower placement in Medicaid member assignment algorithms
  • Reduced efficacy in Risk Score and Quality Measure AI/ML model development
  • Incomplete / inaccurate population health profiles

QMetrics keenly understands 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. The QMetrics team has direct experience working in and with health plans, provider organizations, and hospitals and knows how to evaluate these data to effect meaningful change.

QMetrics’ extensive knowledge in managed care and of the capitated California market allows us to swiftly target areas of weakness and/or data leakage points. The QMetrics approach of extending traditional rapid cycle processes of fast iterative tactical improvements while simultaneously implementing long term strategic interventions has helped a variety of organizations improve their encounter data completeness and increase revenue.

Contact us at info@qmetrics.us on how we can help you make the changes you need to provide a better outcome in encounter data capture and reporting.

®HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA)