Overview
Developed by CMA Physician Services, this customizable template will help provider practices establish or update their policies and procedures for the encounter data submission process. Establishing and regularly updating your practice’s documentation on policies and procedures for encounter data reporting will ensure your practice consistently submits complete, accurate, and timely data capture, documentation, and coding of encounter data.
Author
California Medical Association Physician Services (CMA PSO)
Why use it
The template helps practices formally document all encounter data submission requirements, staff responsibilities, and the process and tools used to ensure complete, accurate, and timely data capture, documentation, and coding. The exercise of filling out the template will help engage staff while simultaneously clarifying the practice team members’ roles and duties. The template can also help identify critical questions for contracted health plans and IPA/PPGs.
Who it’s for
The Encounter Data Policies and Procedures template is intended for front office, business office, billing, and administrative staff at provider practices and community health centers in California serving patients with commercial, Medi-Cal, and Medicare coverage. The template is useful for onboarding new staff members, semi-annual encounter process reviews, and can be customized to reflect health plan and IPA/PPG contract arrangements.
If you are an encounter data subject matter expert and have edits or additions for this template, please fill out IHA’s Contact Us form so your update may be incorporated.
Key take-aways
This customizable template seeks to comprehensively capture all relevant policies and procedures for encounter data reporting. It includes the following sections:
- Policy statements, document purpose, and definitions
- Tables to document procedures by contracted health plan, line of business, and delegated entities
- Encounter data submission schedule
- Encounter data acceptance and validity rates by health plan or delegated entity
- Schedule for rejected encounter data submissions
- Schedule for submitting appeals
- Links to relevant code sets
- Compliance guidelines from DHCS and CMS
Date published
December 2022, revised for formatting January 2023