States blame their Medicaid claims systems for incomplete federal reporting

July 06, 2015

According to an HHS Inspector General report, many state Medicaid programs, which are required to report encounter data - or information about the services provided to enrollees in Medicaid's managed care program - to the Medicaid Statistical Information System aren't reporting such data completely or by deadline, with some states pointing to inadequate data systems as the culprit. The analysis of 2011 claims data notes that the MSIS is a critical tool for analyzing information on Medicaid beneficiaries, services and payment, as well as rooting out fraud, waste and abuse, but that CMS accepted MSIS claims files from six states knowing that it lacked the required encounter data. While four of those states corrected the data system limitations by 2013, two states are still working to correct the limitations. Meanwhile, eight of the 38 states reviewed didn't report encounter data from managed care entities by the required deadline. The report's authors recommend CMS should "withhold appropriate federal funds from states that fail to submit encounter data to MSIS until those states report encounter data as required," which CMS concurred with, adding that it would ensure encounter information is reported for all managed care entities.