Problem to Solve
A major California health care organization found itself unable to meet Medi-Cal’s encounter reporting requirements and faced substantial financial penalties for its non-compliance. The organization’s legacy system had difficulty delivering the complex data that Medi-Cal required. Additionally, Medi-Cal encounter reporting requirements were growing and becoming more difficult, exacerbating the issue.
Before it began incurring Medi-Cal penalties for encounter reporting deficits, the health care organization acted quickly to address its needs and engaged Freed Associates (Freed) to manage its efforts. Freed knew the organization and the complexities of Medi-Cal data compliance well, and could provide the objective support needed to properly assess and sustain this initiative.
The health care organization needed to deliver several years’ worth of encounter data to Medi-Cal, as well as comply with ASC X12 EDI standards. Because this project affected more than a dozen of the health care organization’s contracted Medi-Cal plan partners, Freed also needed to manage and coordinate reporting-related issues and communications among the plan partners.
Besides overall project management strategy and execution, including collecting and maintaining all project-related documentation and communication, Freed worked with the health care organization on the following:
After several months, the project team began delivering to Medi-Cal its required encounter reporting data. This meant that the client would no longer need to rely on its prior, ineffective encounter reporting solution, and could proceed with a more capable and accurate reporting system.
Ultimately, the new encounter reporting solution provided the type and degree of data quality, completeness and timeliness that Medi-Cal sought. This new system also improved the health care organization’s ability to detect and resolve encounter reporting errors, as well as reduce the number of issues affecting the organization’s plan partners.
Strategically and methodically, the health care organization built a new encounter reporting solution, and became data-compliant, able to deliver on its backlog of prior encounter data, and mitigate potential financial losses from Medi-Cal penalties. The organization also created a workable, systemic approach for delivering future data, including creating a vital error correction and re-submission team.
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