Encounter Data in Medicare Advantage

Medicare Advantage encounter data is intended to capture the details of a Medicare Advantage beneficiary’s health and treatment based on “encounters” with clinicians. This data is used to understand the health status of enrollees.

Key Facts:

• Medicare Advantage encounter data are detailed records about Medicare Advantage enrollees’ health care.

• CMS uses encounter data to determine and validate payments, as well as to evaluate the MA program.

• CMS has been moving towards greater use of encounter data for risk adjustment and plans to move to 100% use in 2022.

Policy Recommendation:

BMA encourages CMS to ensure there is technical support available to Medicare Advantage plans and providers for any questions on the encounter data system related to the submission of encounters and urges CMS to permit the use of audio-only telehealth encounters for risk adjustment.

Fact Sheet

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