Press ReleasesBLOG POST: Push intensifies to include audio-only telehealth in MA risk adjustment

Telehealth – and audio-only telehealth in particular – became critical for care delivery in Medicare Advantage over the past year, but a CMS policy excludes audio-only encounters from MA risk adjustment calculations. ¹

The Alliance of Community Health Plans, along with AHIP and other industry stakeholders, sent a letter urging CMS to revise the policy, arguing that the exclusion will lead to inaccurate and incomplete documentation of diagnoses. Current rules “leave health plans and providers with fewer resources and potentially exposing patients to reduced benefits, higher premiums and increased out-of-pocket costs,” they wrote. ^1,2

Telehealth use jumped among Medicare enrollees during the COVID-19 pandemic, and 56% of all beneficiaries had audio-only telehealth visits.³ That figure was even higher among enrollees in rural and underserved communities, as well as older beneficiaries and people of color, highlighting the role these visits play in capturing a full picture of participants’ health and the risks of excluding them as health plans seek to bridge disparities and gaps in care.^3,1

CMS is allowing MA plans to factor in video-based telehealth visits to gauge members’ health for 2020 and 2021, but that policy hasn’t been expanded to audio-only encounters, although audio-only care is allowed in Affordable Care Act marketplace plan risk adjustment calculations. Extending the inclusion of audio-only encounters to MA is not just about ensuring plans are appropriately reimbursed, stakeholders wrote to CMS.  “Including all encounters in risk adjustment also provides clinical care teams the information necessary to comprehensively manage their patients’ care,” they said.¹

Addressing the issue will be even more important if related legislation clears Congress. A bill that would make coverage permanent for audio-only telehealth under Medicare was recently introduced in the House of Representatives.⁴

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References

1. Health Care Industry Leaders Urge CMS to Include Audio-Only Telehealth Encounters in Risk Adjustment. Alliance of Community Health Plans. June 3, 2021. Accessed June 9, 2021. https://achp.org/letter-health-care-industry-leaders-urge-cms-to-include-audio-only-encounters-in-risk-adjustment/
2. King, Robert. Payer, provider groups clamor for CMS to add audio-only telehealth visits to MA risk adjustment. Fierce Healthcare. June 4, 2021. Accessed June 9, 2021. https://www.fiercehealthcare.com/payer/payer-provider-groups-clamor-for-cms-to-add-audio-only-telehealth-visits-to-ma-risk
3. Koma, Wyatt, et al. Medicare and Telehealth: Coverage and Use During the COVID-19 Pandemic and Options for the future. Kaiser Family Foundation. May 19, 2021. Accessed June 9, 2021. https://www.kff.org/medicare/issue-brief/medicare-and-telehealth-coverage-and-use-during-the-covid-19-pandemic-and-options-for-the-future/
4. Wicklund, Eric. Congress to debate Medicare coverage for audio-only telehealth services. mHealth Intelligence. May 26, 2021. Accessed June 9, 2021. https://mhealthintelligence.com/news/congress-to-debate-medicare-coverage-for-audio-only-telehealth-services