Here are some things to think about as we transition from submitting RAPS to submitting encounter data.
What is your strategy for submitting encounter data in the 5010 format?
Are you going to build your platform internally or use an outside vendor?
MA organizations will now submit data from all types of services. Do you have capacity to submit the increased volume of data that this change will require?
Will the number of rejected files increase and are you prepared to handle the volume?
How will the differences between paper claims and the 5010 format impact this process?
How will deletes now be handled through this new process?
How will your additional chronic conditions that are currently captured through retrospective chart reviews now be handled?
Some systems have limitations in how many ICD-9 codes are stored, what process will you have to ensure that any ICD-9 codes that could not be stored/captured in your claims processing system make their way to CMS?
Have you considered how you will modify your processes to accommodate the shortened timeframes for submitting your data? You will now only have 12 months from the date of service to submit encounter data.
You will now be required to submit data monthly as opposed to quarterly.
What types of reports will we need from CMS and/or to create internally to manage this increased volume of submissions, deletions, rejects?
These are just some questions that come to mind for me. I am sure there are a lot more to consider as we begin to go through the testing phase! It would be great to share as many thoughts, concerns, questions so that we are all as ready as we can be when the switch is flipped on January 3, 2012.
Kimberly D. Stone, Director of Medicare Revenue Management, Government Programs Administration
PRESBYTERIAN HEALTHCARE SERVICES
