Applicability of Diagnoses from Telehealth Services for Risk Adjustment in Medicare Advantage

The COVID-19 pandemic has created an urgency to expand the use of virtual care to reduce the risk of spreading the virus. CMS is stating that Medicare Advantage Organizations and other organizations that submit diagnoses for risk adjusted payment are able to submit diagnoses for risk adjustment that are from telehealth visits when those visits meet all criteria for risk adjustment eligibility. It is important for enrollees in Medicare Advantage to be able to receive clinically appropriate services via telehealth, and CMS appreciates all the necessary steps Medicare Advantage Organizations are taking to help providers and members cope with the pandemic.

Memo