June 3, 2021
ACHP and other health care industry leaders such as AHIP, AMGA and the Blue Cross Blue Shield Association urge CMS to allow audio-only encounters to be included in Medicare Advantage risk-adjustment. Allowing MA plans to submit diagnoses from all telehealth services for risk-adjustment is imperative to ensure that health costs are adequately captured, premiums are stable and robust benefits are preserved. Including all encounters in risk-adjustment also provides clinical care teams the information necessary to comprehensively manage their patients’ care. Without the complete and accurate documentation of diagnoses, MA plans are experiencing reductions in payments, leaving health plans and providers with fewer resources and potentially exposing patients to reduced benefits, higher premiums, and increased out-of-pocket costs in the future.