Outpatient encounter data for risk adjustment: strategic issues for Medicare and Medicaid.
Payers are increasingly using diagnostic data from outpatient encounter records to adjust the payment to health plans. Although much has been written about the ability of such data to predict health care costs, little has been written about the data itself--its quality and availability. Fee-for-serv...
| Publicado en: | Journal of Ambulatory Care Management Vol. 25; no. 3; pp. 1 - 16 |
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| Autor principal: | |
| Formato: | tables/charts Journal Article |
| Publicado: |
Lippincott Williams & Wilkins
Jul2002
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106957021&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106957021 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01489917 0NV jtl: Journal of Ambulatory Care Management issn: 01489917 maglogo: N pubinfo: dt: Jul2002 vid: 25 iid: 3 pid: 5086 pub: Lippincott Williams & Wilkins place: Baltimore, Maryland artinfo: ui: 106957021 106957021 2002111083 10.1097/00004479-200207000-00002 NLM12141013 106957021 ppf: 1 ppct: 15 formats: fmt: @attributes: type: P tig: atl: Outpatient encounter data for risk adjustment: strategic issues for Medicare and Medicaid. aug: au: Welch WP affil: Senior Healthcare Economist, Mid Atlantic Medical Services, Inc., Rockville, MD sug: subj: Fee for Service Plans Data Collection Insurance, Health, Reimbursement Managed Care Programs Medicare Medical Records Medicaid Clinical Information Systems Data Collection Methods Managed Care Information Systems ab: Payers are increasingly using diagnostic data from outpatient encounter records to adjust the payment to health plans. Although much has been written about the ability of such data to predict health care costs, little has been written about the data itself--its quality and availability. Fee-for-service (FFS) data face several threats to their validity, including the possibility that they may seriously underreport diagnoses. Because the systems and incentives that yield FFS and managed care diagnosis data are quite different, they may not be comparable, depending on circumstances such as audit rules. The next generation of risk adjustment models should be designed around the capabilities and potentialities of plans' information systems. Copyright © 2002 by Aspen Publishers, Inc. pubtype: Academic Journal doctype: tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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