Qualified Patient Encounters

You may be hearing stuff about how Medicare Advantage is transitioning from something called “RAPS” to something else called an “EDS” for risk code collection—and how it’s going to devastate your cash flow.



Don’t worry about it.



Those acronyms simply refer to different sets of patient encounters from which data is pulled for data-based payment.



Medicare believes one set will create a more accurate representation of a patient’s disease burden and insurers believe the opposite—and that any changes will cut their revenue.



For all but the top-level strategic planners, you don’t need to know the details.



You need to keep your eye on the ball.




All you need to know is that under either system, risk diagnoses will still only be able to be submitted as the result of a “qualified patient encounter.”




“Qualified patient encounters,” for your purposes, are face-to-face visits between the patient and the clinician in the setting of a hospital—as either an inpatient or observation stay, or in the ER, nursing home, office, residential care center, rest home or (under specific circumstances) a house call.




Not the phone, not via telehealth (not yet at any rate), not via email.




Not by DME providers or radiography reports.




Not by therapists




Only the face-to-face encounters above count.




That’s all you need to know.



Now act on that knowledge






Executive, administrator or clinician; here are even more specific, actionable tactics for Medicare Advantage Success.  Strategic thoughts and tactical pearls are posted every Monday and Thursday, sign up for delivery to your inbox and never miss a single one!


Last week’s high-value tactic.


Stay ahead of the managed care curve with topical weekly intelligence and immediately useful insights—and receive a value-packed free white-paper tailored specifically to your circumstance–subscribe to Value-Based Transformations today!


You can catch unique, high-value content including live-streams on my Professional Facebook page.


Collaborate with us through LinkedIn.


Interact with us via Twitter.


Like my Facebook Page.


Catch valuable videos and live-streams on my YouTube channel.


Want a high-value jumpstart?  Just published with the latest information, tools, and tactics, Medicare Advantage Mastery will set you on your way with your first 12 steps to excellent managed care performance.