Medicare Advantage Encounter Data Integrity Protocol Management

Specifically, Mathematica is helping to update the Medicare Advantage Encounter Data (MA ED) Integrity Protocol, which provides Medicare Advantage Organizations with guidance on collecting and validating the accuracy and completeness of the encounters they submit; offering options to improve technical assistance to CMS contractors in implementing the protocol and document implementation progress; and if necessary, modifying the protocol to obtain more accurate and complete encounter data. 

In addition, Mathematica is (1) reviewing and analyzing CMS’s guidance materials on submission of encounter data to identify inconsistencies, if any, and assisting with reconciling/clarifying guidance; (2) determining which content can be archived and which content is current; (3) reviewing guidance on CMS’s processing of encounter data and help in drafting a new document reflecting current guidance on all relevant topics for ED; (4) reviewing and helping in determination of changes needed in the operational manual; and (5) developing a CMS-based web page with links to all current guidance and manuals.

In a major part of the project, Mathematica is conducting rigorous analyses of the MA ED related to system processing analytics (e.g. analysis of error patterns and derived variables), assessment of data completeness and quality, and development of key performance metrics for the production of ED report cards on each Medicare Advantage Organization’s MA ED submissions. Our role includes: (1) planning these analyses with input from internal and external stakeholders; (2) conducting analyses for assessment of data completeness and quality; (3) producing MA ED analysis files and contract-level metrics; and (4) producing 508-compliant report cards informing reporting organizations of systematic and/or significant data submission quality problems.