Effective November 5, 2021, CMS introduced an edit to determine if submitted records are duplicates based on several data elements.
Santa Ana, CA – December 12, 2021 – Dynamic Healthcare Systems, a leading provider of enterprise-wide solutions to health plans participating in Medicare Advantage, Managed Medicaid, and Marketplace programs, has incorporated the CMS Medicare Advantage software improvements announced on October 20, 2021 into Dynamic’s Encounter Data solution. The timely updates to Dynamic’s solution provide Dynamic’s clients with compliant Encounter Data Processing System (EDPS) submissions without burdening the Medicare Advantage Organizations (MAOs).
As CMS continues to implement software changes to enhance and support the Medicare Advantage program, Dynamic exists to relieve MAOs of the burden of complying with these frequent and nearly immediate updates. On October 20, 2021, CMS issued a memorandum regarding chart review reject edits 98320 and 20510 within the EDPS, which became effective for submissions as soon as November 5, 2021.
In the Encounter Data Software Release Updates: 2021 Quarter 4 Release, edit 98320, a chart review reject edit, applies to validating chart review submissions determining if duplicates exist based on specific data elements. CMS enhanced the logic by adding criteria to flag duplicates accurately between Chard adds and deletes. Edit 20510, an institutional reject edit, relates to ambulance services submitted with particular Healthcare Common Procedure Coding System (HCPCS) codes.
The flexibility and differentiators in Dynamic’s Encounter Data solution allow Dynamic to make regulatory or business changes on-demand to pre-processing validations to ensure accurate encounter data is submitted to CMS. Dynamic’s solution centers on normalizing source data, standardizing validations, automatically processing files, and providing tools to identify and review errors. The filtering and validation logic used is why Dynamic’s first-pass successful acceptance rate is over 99%.
“As a trusted partner to MAOs, Dynamic Healthcare Systems has updated its Encounter Data solution and submission offering with these latest regulatory changes”, states Jim Corbett, Chief Strategy Officer at Dynamic. “The Encounter Data solution enables the MAO to create, validate, and submit professional, institutional, equipment, and supplies encounter data to CMS. Dynamic’s Encounter Data solution centers on normalizing source data, automatically processing files, and providing tools to identify and review errors, such as the two new edits,” Corbett added.
About Dynamic Healthcare Systems
Dynamic Healthcare Systems was founded in 2005 in response to the significant business and system challenges placed on Medicare Advantage Organizations (MAOs) by the enacted Medicare Modernization Act of 2003.
Dynamic provides an end-to-end automated SaaS solution for health plans and provider groups participating in Medicare Advantage, Managed Medicaid, and Marketplace programs.
Our comprehensive solutions can help Dynamic’s clients optimize revenue and increase the quality of their governmental submissions in an operationally efficient manner that is designed to comply with applicable legal and regulatory obligations. The analytics, integrated workflows, and queues within a single integrated platform help Dynamic’s clients more effectively manage Enrollment, Premium Billing, Revenue Reconciliation, and Risk Adjustment. For more information, visit dynamichealthsys.com or call 949-333-4565 ext. 125.