Encounter Data Analytics Project | CMS | Rainmakers Strategic Solutions

Rainmakers Awarded Centers for Medicare and Medicaid Services Encounter Data Analytics Project

Ellicott City, MD – Rainmakers Strategic Solutions LLC (Rainmakers) was awarded the Encounter Data Analytics Project by the Centers for Medicare & Medicaid Services (CMS) to help CMS assess its Financial Alignment Initiative, an alternative payment and service delivery model designed to improve the quality of care that individuals dually eligible for Medicare and Medicaid receive. Improving the quality of care for, and expanding access through seamless integrated care to, one of our nation’s most vulnerable population is mission critical. Our playing a part to ensure Medicare-Medicaid Plans submit accurate encounter file submission to CMS contributes to this goal.

“Building out on our six-year partnership with CMS providing Medicare-Medicaid Plan technical assistance, developing claims splitting rules, and performing data analysis, we look forward to continuing our CMS Financial Alignment Initiative work.”

Rainmakers’ team of data analysts and subject matter experts will perform the following key tasks:

  • Assist CMS in ensuring that the Medicare-Medicaid Plans participating in the Financial Alignment Demonstration model are providing necessary care for services provided to the dual population by monitoring encounter file submissions to the Medicare and Medicaid programs
  • Develop benchmarks and conduct analyses of each Medicare-Medicaid Plans’ monthly submitted encounter files to measure and improve completeness and accuracy of submissions
  • Create utilization reports of services provided by the Medicare-Medicaid Plans to understand trends across the participating demonstration years and identify opportunities for improving care
  • Provide CMS technical assistance and operational support during bi-annual meetings with participating State Medicare-Medicaid Plans by leading discussions of analytic results and provide follow-up to CMS and the Plans

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