Health Affairs February 25, 2019
Earlier this year, the Centers for Medicare and Medicaid Services (CMS) released preliminary Medicare Advantage (MA) encounter data from calendar year 2015, providing researchers with potential new insights into patient-provider interactions in MA. CMS defines encounter data as the data necessary to characterize the context and purposes of each item and service provided to a Medicare enrollee by a provider, supplier, physician, or other practitioner. Encounter data are often referred to as claims data although in the MA program under capitated payment no claim for payment may actually be made.
Encounter data are becoming more salient as enrollment in MA increases, accounting for more than one-third of total Medicare enrollment in 2019 and surpassing 40 percent of total enrollment in...
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