Hospitals and provider groups across the country were the first to feel the effects of COVID-19 as they scrambled to adapt to or dramatically increase telehealth visits as stay in place measures took effect. Managing patients remotely through virtual settings at scale became critical. Two major questions bubbled up as providers switched over to this new medium.
The updated CMS telehealth guidelines for Medicare Advantage (MA) plans allow telehealth visit claims to be counted towards the Risk Adjustment calculations for the contract year.
In response, our friends at the Centers for Medicare & Medicaid Services (CMS) stepped up to encourage healthcare providers to adopt telemedicine visits to deliver virtual care in the absence of in-person medical visits. However, telehealth flexibility also increases concerns about potential fraud, waste, and abuse (FWA) and there will undoubtedly be some downstream reverse engineering by CMS to mitigate these inherent risks.
We have seen an exponential growth in the number of telemedicine visits being performed since the pandemic’s arrival on our shores. While this growth is expected to plateau, telemedicine is here to stay well beyond the pandemic. A recent article by Becker’s Hospital Review, “Trump directs federal agencies to make telehealth reforms ‘totally permanent,”(1)
Telemedicine has exploded out of necessity to address healthcare needs amidst stay in place constraints, but it’s created new reimbursement changes especially for the value-based care market. This is the first in a series of five…
The American healthcare industry will undergo significant disruptions as the coronavirus crisis penetrates the American landscape. Three critical events are already affecting the Risk Adjustment operations process at America’s health plans for 2020.