Getting a Handle on Medicare Advantage Encounter Data

Dean Stephens
March 1, 2019

As the Medicare Advantage season approaches, did you know that Medicare Advantage encounter data is becoming more and more important as enrollment in Medicare Advantage continues—which is projected to reach an all-time high in 2019? Did you know the three primary uses of encounter data, how CMS plans to use the data and how this data is used to calculate risk scores? Check out this recent blog in Health Affairs, The Promise and Pitfalls of Medicare Advantage Encounter Data.

Talix has a lot of experience with encounter data. For example, we help health plans "risk stratify" members and encounters based on HCC coding gaps using our market leading NLP.  Since most health plans have a finite staff—and finite resources—Talix helps focus on members and/or encounters with the most gaps. At the same time, Talix can increase coder productivity for encounter reviews through our unique workflow design. Combined with our NLP engine, we increase accuracy by aiding coders to shore up anything that they may have otherwise overlooked. Talix also supports provider outreach and education through encounter data analytics that identify providers with the most HCC coding gaps. Our analytics engine helps manage and track KPIs for the risk adjustment lines of business leading to greater efficiency, accuracy and productivity.

Learn more about Talix by contacting us and scheduling a demo.

Dean Stephens is the CEO of Talix.
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