Plans Want Diagnoses From Phone Visits Included in MA Risk Adjustment

A health insurer trade group is calling on the federal government to change Medicare Advantage (MA) risk adjustment calculations to include telephone visits, saying the issue has become urgent due to the pandemic, which has seen in-person visits drop and telehealth visits increase dramatically.

CMS determines MA enrollee risk scores based on diagnoses submitted by MA organizations through the Encounter Data System, which are then used to determine a plan’s risk-adjusted payments. When CMS expanded reimbursement eligibility for telehealth visits as part of its pandemic response, the agency allowed video telehealth visits to be included in risk-adjustment calculations. However, CMS currently does not allow telephone encounters to be included in risk score calculations.

0 Comments
© 2024 MMIT
Peter Johnson

Peter Johnson

Peter has worked as a journalist since 2011 and has covered health care since 2020. At AIS Health, Peter covers trends in finance, business and policy that affect the health insurance and pharma sectors. For Health Plan Weekly, he covers all aspects of the U.S. health insurance sector, including employer-sponsored insurance, Medicaid managed care, Medicare Advantage and the Affordable Care Act individual marketplaces. In Radar on Drug Benefits, Peter covers the operations of (and conflicts between) pharmacy benefit managers and pharmaceutical manufacturers, with a particular focus on pricing dynamics and market access. Before joining AIS Health, Peter covered transportation, public safety and local government for various outlets in Seattle, his hometown and current place of residence. He graduated with a B.A. from Colby College.

Related Posts

medicare-part-c
May 17

Medicare, Medicaid Segments May Be a ‘Mess,’ but Bounce-Back Expected

READ MORE
hospital-hallway
May 17

As Hospitals’ Commercial Prices Keep Rising, Experts Float Solutions

READ MORE
businessman-viewing-news-update-journalism-headline-on-a-laptop
May 17

News Briefs: CMS Extends Medicaid Redetermination Deadline

READ MORE

GAIN THERAPEUTIC AREA-SPECIFIC INTEL TO DRIVE ACCESS FOR YOUR BRAND

Sign up for publications to get unmatched business intelligence delivered to your inbox.

subscribe today