THE USEFULNESS OF HCC CLOSE GAPS FOR THE MEDICARE ADVANTAGE PLANS Remote patient monitoring or telehealth service are just another feature that Medicare Advantage Plans are providing to the enrollees. The Centers for Medicare & Medicaid Services (CMS) stated that it has completed modifications that would allow Medicare Advantage (MA) enrollees to get quality healthcare services from settings such as their residences instead of needing to commute to a healthcare setting for treatment.
The change in policy, published as a final rule, is part of CMS's attempt to transform the MA program (Part C) standards and the Prescription Drug Benefit program (Part D) regulations in order to stimulate innovation and growth among private Medicare health and drug plans and increase competitiveness for quality care. Even though Medicare Advantage Plans have been entitled to provide certain telehealth services in the context of their additional advantages, the CMS's final rule permits them to include more telehealth services and increase access to more healthcare providers and in more areas of the country than previously. The CMS official statement allows MA plans greater leeway in providing additional benefits that identify socioeconomic determinants of health to chronically sick patients. About 81 percent of MA plans incorporated remote access technologies as part of their supplementary telehealth features.
MA Plans and HCC Close Gaps A Hierarchical Condition Category, or HCC is a collection of diagnoses that CMS utilizes in its risk-adjusted reimbursement system for Medicare Advantage plans. These codes are the most important markers of a member's health condition. The vast majority of HCCs are chronic diseases. Diagnoses are extracted from claims data provided after an encounter with the authorized healthcare practitioner. The program's objectives are as follows: • Increase the number of visits to primary care providers. • Collect and report the health condition and severity of Medicare Advantage participants quickly and precisely. • Close individual diagnostic gaps and enhance overall preventative patient care for participants. Documenting and recording HCC codes properly ensures accurate risk adjustment scores for appropriate and fair payer allocation of resources, as well as aids in HCC Close Gaps. Medicare Advantage Plans around the country are trying to target and preserve certain spots in order to maintain a competitive lead. To fulfill this goal, the Medicare Advantage Plans are following strategies that include identifying older adults at high risk, and working for HCC Close Gaps in Care, such as cancer tests or prescription refills, and improving care delivery by trying to engage seniors in their health on a constant basis.