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Encounter Data 101

March 2022

CMA Physician Services’ Encounter Data 101 Presentation was developed to highlight the importance of encounter data submission for provider practices. This presentation will help providers and their staff understand the purpose of submitting timely and accurate encounter data, identify the difference between encounter and claims data, and share tips on how to improve encounter data submission.

Author

CMA Physician Services
Mitzi Young, Associate Director of Practice Strategy in the Center for Economic Services
Vincent Vinh, Associate Director of Physician Services

Why use it

Many providers may be asking themselves, what is the encounter data problem and what does it mean to me? The Encounter Data 101 Presentation covers the essential information on what encounter data is, why it matters, and how providers can begin to improve encounter data processes.

Who it’s for

Providers, quality improvement managers, front office staff, billing and coding staff.

Key take-aways:

The tools you need to start improving your encounter submission may be more accessible than you think! To get started, gather what’s available in the following categories:

  1. Resources from your contracted health plans referring to timely and accurate claims and encounter data submission
  2. Policies documenting your organization’s current coding and billing processes
  3. EHR templates from your EHR vendor
  4. P4P, HEDIS, or quality measures scorecards from your health plans (or from IHA’s AMP program if you’re an AMP participant)
  5. Supporting materials from your clearinghouse to address errors and rejections

Have edits or additions for this resource? Please let us know.

IHA’s Resource Hub is made possible through a grant from Health Net, LLC’s Encounter Data Improvement Program.

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