New Audits and Penalties on Medicaid Plans and Providers Related to Encounter Data in Value-Based Payment Models

Pratt’s Government Contracting Law Report March 2018

Jackie Selby, Member of the Firm, and Gregory R. Mitchell, Associate, in the Health Care and Life Sciences practice, in the firm’s New York office, co-authored an article in Pratt’s Government Contracting Law Report, titled “New Audits and Penalties on Medicaid Plans and Providers Related to Encounter Data in Value-Based Payment Models.”

Following is an excerpt (see below to download the full version in PDF format):

With the growing prevalence of value-based payments, especially in Medicaid programs, the focus on encounter data is growing. The federal government and many states are currently tying the receipt of payments to the timely submission of complete and accurate encounter data, and are requiring states to audit Medicaid managed care plans’ encounter data to ensure that such data is timely and accurate. The authors of this article discuss the trend and suggest that plans and providers ensure that their encounter data collection and submission processes are robust, accurate, and compliant with federal and state laws and regulations.

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