Reducing CMS Submission Risk by Identifying Combined Billing Issues Early

The Challenge: Combined Billing Created Hidden Data Risks

A large health system was experiencing complex combined billing workflows, where patients moved between facilities during a single episode of care. Encounters were often created as separate accounts and later merged for final billing.

This created significant risk across their quality reporting process, including duplicate cases, conflicting identifiers, incorrect encounter dates, and mismatches in CMS populations. Without early visibility, these issues could surface late in the submission cycle, putting data accuracy and validation at risk.

The Turning Point: Reporting Revealed the Root Cause

Using Medisolv’s reporting tools within the ENCOR for Hospital Abstracted Measures module, the team was able to uncover these issues early before they impacted abstraction or submission.

The Invalid Import Results Report flagged cases where duplicate identifiers or conflicting CCNs and CMS Medicare IDs prevented proper processing. At the same time, the Cases Not Qualified for Any IPP Report helped identify cases that were appearing in files but not qualifying for any measure populations.

Together, these reports exposed a clear pattern tied to combined billing workflows; something that would have been difficult to detect through standard processes.

The Solution: Identifying Issues Before Submission

With this visibility, the organization was able to take action early in the reporting process.

They avoided abstracting cases that would later need to be merged or deleted, corrected encounter date issues before validation failures, and ensured procedures were attributed to the correct episode of care.

The Results: Improved Accuracy and Reduced Risk

By leveraging Medisolv's ENCOR solution and its reporting capabilities, the organization was able to:

• Prevent duplicate and invalid cases from being abstracted
• Correct encounter date discrepancies prior to validation
• Improve alignment between reported populations and claims data
• Enable proactive collaboration with coding teams to fix upstream workflows

The Impact: From Reactive Fixes to Proactive Improvement

Just as importantly, the team shifted from reactive troubleshooting to proactive process improvement.

By working closely with coding teams, they adjusted workflows upstream to prevent these issues from recurring and reducing risk and improving confidence in their data.

Why It Matters: Data Integrity Is the Foundation of Accurate Reporting

Combined billing workflows are increasingly common and increasingly complex.

Without the right reporting tools, these scenarios can quietly introduce risk that surfaces too late, during submission or validation. Early visibility is critical to maintaining accurate, compliant reporting.

The Takeaway: A Safeguard for Data Accuracy

This story highlights how Medisolv goes beyond supporting abstraction.

By identifying data integrity risks tied to real-world billing complexity, Medisolv helps organizations protect submission accuracy, reduce validation risk, and stay ahead of regulatory requirements.

Move Beyond Reporting, Start Improving Data Accuracy

Medisolv's ENCOR for Hospital Abstracted Measures helps you identify data integrity issues early, streamline abstraction, and ensure every case is accurate before it’s submitted. See how ENCOR works >>

**EDITOR'S NOTE: Out of respect for client privacy, we have removed any identifying information about the hospital. We thank the hospital’s leadership team for allowing us to share their story.