A number of different pieces of information about the services received by the health plan member or a group of members is what makes up encounter data. An "encounter" is defined as the interaction that occurs between a health plan enrolled member, and the health care provider that provides a specific service that is insured by the enrollees health insurance plan. Health insurance plans look at this encounter data, which is mostly centered around the cost and amount of the service provided that is billable, to figure out the future costs for this individual, or group of members with similar services rendered.
The information that is collected about a patient, or a group of patients, and the services that they have received from health care providers is what encounter data is comprised of. There are a number of aspects within this that are looked at more deeply. Encounter data will include, when and where the services were provided as well as who provided the services, and who the services were provided to. The use of encounter data can vary, but in many cases it is used as a way to help to develop a cost profile of a group of clients, or an individual. This is one of the main factors looked at when a health insurance company is trying to determine if a raise in premium costs for a group is necessary or warranted.
There are a number of different aspects looked into when health insurance companies develop and consider the most applicable costs in terms of health insurance plan premiums. Each year health plans are looked at and compared to the cost that that individual, or group of individuals, incurred as well as the services that they took advantage of. This information is used to determine the rate of the premium for the next year and whether or not it is raised or lowered. There are a number of factors used when creating this number, one of the main factors that is looked at is the encounter data for that individual.
Encounter data is one of the most important forms of service records for health care providers, insurance companies and patients. It is a record of the treatments that they have received, and when the records are not done accurately they can provide information that leads to lower, or much higher, estimations of yearly health care costs. In many cases it has been found that a lack of precise and exact encounter data will lead to a possible increase of health care costs. In other cases, the incorrectly, or not recorded, encounter data translates to a risk adjustment that is too little, and then costs the health plan provider more money to make up the difference. Many states are beginning to put into place and implement more accurate encounter data collection, and others are offering incentives for providing more of this data.
Many states are enacting an encounter data collection plan as a way to try to lower health care costs, and more accurately provide premiums that reflect the patient's use of the health care plan. In addition the Centers for Medicare and Medicaid Services have created an encounter data collection and use plan as well. Proper encounter data collection and analyzing is thought to possibly help improve the rising costs of our health care system.
The information that is collected about a patient, or a group of patients, and the services that they have received from health care providers is what encounter data is comprised of. There are a number of aspects within this that are looked at more deeply. Encounter data will include, when and where the services were provided as well as who provided the services, and who the services were provided to. The use of encounter data can vary, but in many cases it is used as a way to help to develop a cost profile of a group of clients, or an individual. This is one of the main factors looked at when a health insurance company is trying to determine if a raise in premium costs for a group is necessary or warranted.
There are a number of different aspects looked into when health insurance companies develop and consider the most applicable costs in terms of health insurance plan premiums. Each year health plans are looked at and compared to the cost that that individual, or group of individuals, incurred as well as the services that they took advantage of. This information is used to determine the rate of the premium for the next year and whether or not it is raised or lowered. There are a number of factors used when creating this number, one of the main factors that is looked at is the encounter data for that individual.
Encounter data is one of the most important forms of service records for health care providers, insurance companies and patients. It is a record of the treatments that they have received, and when the records are not done accurately they can provide information that leads to lower, or much higher, estimations of yearly health care costs. In many cases it has been found that a lack of precise and exact encounter data will lead to a possible increase of health care costs. In other cases, the incorrectly, or not recorded, encounter data translates to a risk adjustment that is too little, and then costs the health plan provider more money to make up the difference. Many states are beginning to put into place and implement more accurate encounter data collection, and others are offering incentives for providing more of this data.
Many states are enacting an encounter data collection plan as a way to try to lower health care costs, and more accurately provide premiums that reflect the patient's use of the health care plan. In addition the Centers for Medicare and Medicaid Services have created an encounter data collection and use plan as well. Proper encounter data collection and analyzing is thought to possibly help improve the rising costs of our health care system.
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