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Overview

The HICE Encounters Standardization Team convenes industry members on a weekly basis to review, problem-solve, and analyze encounter data coding or procedural standards for adoption. Through consensus-based decision making, the Team is working through encounter data questions and developing recommendations that include coding logic, procedural guidance, “best practices,” and reporting instructions. The Team, with the support of HICE and IHA staff, works to promote alignment with the California Department of Health Care Services (DHCS) and federal standards and requirements. The team was originally established in 2013 as the “Member Out of Pocket (MOOP)” team to address the challenges around submitting member cost share data to CMS and was renamed in 2016 to reflect its current focus on encounter data standardization more broadly.

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Author
Health Industry Collaboration Effort (HICE)

Why join
Joining the Encounters Standardization Team allows encounter data experts to collaborate on and share solutions for encounter data challenges directly with their industry peers. Weekly team meetings provide a dedicated forum to make recommendations on workflow and process improvement strategies that can reduce the administrative burden for payers, providers, and regulators alike.

Who it’s for
Anyone who works with encounter data from a health plan, provider, data vendor organization is welcome. This may include revenue cycle management leaders, managed care operations staff, managed services organization staff, billing staff, quality improvement managers, and EHR (Electronic Health Record) specialists.

Additional information:

There are numerous encounter data challenges currently facing the healthcare industry, so careful prioritization is needed to help move the healthcare community forward strategically toward resolving them. The Encounters Standardization Team, with the support of HICE and IHA staff, is using a repeatable process to standardize the analysis of each encounter data challenge and determine the priority level.

The following factors help illustrate the potential impact and viability of addressing a specific encounter data challenge:

  1. Whether the challenge is leading to downstream data flow effects,
  2. the availability of and consensus around suggested fixes,
  3. any dependencies that would shape the ability for stakeholders to implement a fix, and
  4. whether improvements will be captured in data quality metrics like DHCS’ Quality Measures for Encounter Data, CMS’ Data Quality T-MSIS Priority Items, and Align. Measure. Perform. (AMP) data quality measures.

Once the Team finds consensus on an encounter data recommendation, each recommendation will be brought to IHA’s Data Governance Committee for consideration. Each recommendation will also be shared with other key stakeholders, like the Department of Managed Health Care and the Department of Health Care Services, to support widespread industry implementation. Finalized recommendations will then be shared through the Encounter Data Resource Hub and incorporated into technical assistance efforts for Encounter Data Improvement.

Year established
2013