The Centers for Medicare &Medicaid Services is collecting Medicare Advantage encounter data (information on the services and items furnished to enrollees) to better estimate expected health care costs of enrollees but the agency needs to assess data quality prior to use, GAO has said.
It also said encounter data has a wide range of elements and that CMS has not fully developed plans for using it, according to GAO-14-571.
GAO said the agency plans to begin using diagnoses from both encounter data and the data it currently collects for risk adjustments to determine payments to MA organizations in 2015, but that CMS has not established time frames or specific plans to use encounter data for other potential purposes.
According to GAO, CMS has taken some, but not yet all, appropriate actions to ensure that MA encounter data are complete and accurate. CMS generally agreed to establish specific plans for using MA encounter data and thoroughly assess data completeness and accuracy before using the data to risk adjust payments or for other purposes.
