Audio-Only Telehealth Essential for Risk Adjustment in Medicare Advantage

Risk adjustment is a basic tenet of Medicare Advantage, with data on the health status of each beneficiary required to be collected and reported each year. This year, low utilization of health services due to COVID-19 stay-at-home orders and medical office closures has limited in-person risk assessments in 2020.

Clinical services have transitioned to video and audio-only telehealth visits, with diagnoses obtained in audio-only visits excluded from use for risk adjustment. Many Medicare beneficiaries do not have access or capacity to use video technology and prefer audio-only. Better Medicare Alliance recommends that CMS accept diagnoses obtained during audio-only telehealth visits to count towards a beneficiary’s risk score in a way that is workable for health plans, providers, and beneficiaries.