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Encounter data for physician practices

October 2022

Developed by CMA Physician Services, these easy-to-digest info sheets outline how encounter data supports the sustainability and success of physician practices in California, the similarities and differences between encounter and claims data, and how each staff member impacts the encounter data submission chain. These printable info sheets will help clinicians and staff at provider practices understand why encounter data matters and how it is used on a practical level.


California Medical Association Physician Services (CMA PSO)

Why use it

The value proposition info sheet provides a quick overview of encounter data basics for physician practices and provider organizations. It covers the following topics: how encounter data is used, the benefits it provides, what information it captures, how it can be improved, and how it influences systems and processes.

The role-based impact guide outlines how patients, front office staff, back office clinical staff, business office staff, providers, practice operations staff, and health plans/provider group staff all support the accurate and complete capture of encounter data. It also lists use case examples relevant to each role in the submission chain.

The encounters vs. claims data true or false quiz is a fun, educational way for providers and healthcare administrators to test their knowledge. It covers frequently asked questions about encounter data and how encounter data processes may or may not differ from processes for submitting claims data.

Who it’s for

These printable resources are intended for clinicians, front office, business office, billing, and administrative staff at physician practices in California serving patients with commercial, Medi-Cal, and Medicare coverage. These info sheets can be especially useful for onboarding new staff members at a practice site.

Key take-aways

Complete, accurate, and timely data capture, documentation and coding of encounter data directly supports business operations and can lead to increased revenue for practices.

Here’s how:

  • Accurate risk adjustment at state and federal levels leads to better reimbursement for the care of complex patients
  • More complete performance measurement translates to improved incentive/cost-sharing payouts in value-based care arrangements.
  • More accurate data on volume and quality of services providers leads to better capitation rates, improved business sustainability, and more power to negotiate contracts.

Date published

Value Proposition and Role-Based Impact Guide: October 2022

Encounters vs. Claims True or False Quiz: January 2023

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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