Beginning with 2012 Dates of Service, CMS expects MA plans to submit ICD-9 codes via full encounter data on a monthly basis rather than quarterly. To date, CMS has issued guidance that claims (i.e. encounter data) must be passed on to Medicare within 12 months of the Date of Service.  CMS is suggesting that this 12 month deadline will also apply to ICD-9 data gathered from retro chart reviews as well, although you can tell from the guidance that CMS has not yet ruled on this definitely.

For your reference, pdf files – click to download.

Scan HealthPlan Encounter Data FAQ

CMS Full Encounter Data QAs 10.29.2010

Summary Notes.Chart Reviews.02-16-11 (From CMS Chart Review Work Group – www.tarsc.info)

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