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CMS Encounter Data System Program

Investment ID: 009-000409885


Program Title
CMS Encounter Data System Program
The primary objective of this investment is to collect encounter claims data. This initiative involves the collection, editing, storage, and pricing of claims data for over 20 million (and growing) beneficiaries enrolled in the Medicare Advantage Program.
Type of Program
Major IT Investments
Multi-Agency Category
Not Applicable

Investment Detail

The nature of the EDPS system does not align with standard ROI analysis. We conducted an alternative analysis to qualitatively analyze the benefits of EDPS in accordance with the statutory requirements for Encounter Data collection. The analysis performed against three identified technical options for the EDPS system resulted in a positive NPV for the current technical solution and a negative NPV for two other potential technical solution paths that explored a steady state activity and previously from a cost savings / avoidance perspective In FY18 we transitioned and procured a new system at the average cost of the old system on an annual basis and this will lead to an average of $7.5M per year savings moving forward. The transition to a cloud based infrastructure allows CMS to be better positioned and respond to an increasing MA population and submission patterns of Encounter Data. Encounter Data is collected following guidance provided by Final Fiscal Year (FY) 2009 Inpatient Prospective Payment System (IPPS) rule. In that rule, revised regulation clarifies CMS' authority to require MAOs submit encounter data for each item and service provided to MA enrollees. Additionally beginning with payment year (PY) 2015, CMS began using encounter data as an additional source of diagnoses for risk adjustment payment to MAOs. For payment years 2016 and 2017, CMS continued the transition moving towards use of encounter data as the sole source of plan-submitted diagnosis information.

IT Program Budget


Technology projects under the CMS Encounter Data System Program program

Supporting IDVs

Example IDV awards for CMS Encounter Data System Program

Supporting Contracts

Example prime contract awards for CMS Encounter Data System Program