Home Encounter Data Improvement Resources Understanding the encounter data pathway

Understanding the encounter data pathway

February 2024

This training outlines key steps in the encounter data flow from the health center to the payor for both Medi-Cal and Medicare lines of business. The presentation covers where in the process errors are commonly seen to help health center staff optimize workflows and improve their data throughputs.

Author

California Medical Association Physician Services Org (CMA-PSO)

Why use it

Navigating encounter data complexity is a major challenge for administrative staff at community health centers across California. The Encounter Data Pathway Overview is a companion training presentation for the Improving encounter data & revenue cycle management bootcamp and breaks down the two main pathways that encounter data takes to reach its final destination as a source of truth to inform rate development, care coordination, and quality measurement.

Who it’s for

This training provides foundational information regarding encounter data and common errors that occur. It is suitable for all staff at a community health center with a focus on front office staff, medical billers, and revenue cycle managers.

Key take-aways

The Encounter Data Pathway training covers the following topic areas:

  • Elements of an encounter
  • Phases of an encounter and associated errors
  • The path from health center to DHCS for Medi-Cal encounters
  • The path from health center to CMS for Medicare encounters
  • How encounter data can be used to identify gaps in care
  • Potential process errors in both the front-end and middle phases of encounter data throughputs

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.

Share This