Telehealth Risk Adjustment During COVID-19


CMS Allows Risk Adjustment Via Telehealth

Good news! You can use telehealth visits for Medicare Advantage risk adjustment. To help during COVID-19, CMS has now approved telehealth visits to gather encounter data for risk adjustment coding.1


Why it matters

Since traditional retrospective and in-home programs aren't feasible right now, this move allows Medicare Advantage plans—who insure the oldest and sickest patients—to stay on track with risk adjustment, while allowing PCPs to maintain quality of care.


How to qualify

Health plans and providers using telehealth for risk adjustment can meet the face-to-face requirement when the encounter data is gathered through audio and video telecommunications that permit real-time, interactive communication.


A New PCP-Centric Telehealth & Risk Adjustment Solution

To deliver the best and most compliant risk adjustment results, and to help health plans support their providers, Vatica Health has launched the first PCP-centric telehealth solution for risk adjustment.

Vatica Health's PCP-centric telehealth solution includes:

Core Telehealth Solution


PCP Networks

We have, and continue to build, deep working relationships with PCPs via our embedded Vatica Clinical Consultants.


PCP Support

As with our innovative in-office solution, Vatica Health now offers remote clinical and administrative support for PCPs.


Remote EMR Access and Connectivity

Rather than utilizing external telehealth clinicians with no connectivity to EMRs or the members’ PCP, our VCCs use proprietary technology and remote EMR access/connectivity to enable PCPs to perform telehealth visits themselves, without disrupting their workflow.

Enhanced Telehealth Solution


Audio and Video Interface

With an easy-to-use video call interface, there are no required downloads or apps.


Member engagement

Integrated patient outreach tools and services make it easy for providers to generate appointments and member engagement.


COVID-19 Compliance

Vatica Health is a compliance-first organization, and our proprietary technology and telehealth platform comply with the new CMS telehealth waivers and guidance.

Try our Telehealth + Risk Adjustment Solution


If you're a provider and are interested in our Telehealth + Risk Adjustment solution, email

We're Here to Help

We applaud CMS for supporting Medicare Advantage plans and other at-risk entities. We also empathize with providers and patients; we know there are many stressors in today's environment and learning a new technology and workflow to enable care can be an additional challenge.


Approximately 8 out of 10 PCPs report "severe” or “close to severe” strain on their practices due to COVID-19.2


Telehealth usage is increasing but can be disjointed between audio and video methods using external telehealth solutions. 


Only one-third of PCPs feel confident that their practice has enough cash to continue operating for the next month.3

During this time, when PCPs are under considerable stress, and their financial viability is threatened, health plans should support and encourage PCPs to provide care to patients using real-time telehealth solutions.

Resources for Implementing an Effective RA Telehealth Program 

Webinar: Strategies to Risk Adjust Your Members During the COVID-19 Pandemic

Health plans, learn how to navigate and optimize the new telehealth risk adjustment landscape. Hear from our CEO, Hassan Rifaat, MD & Mara McDermott, Vice President at McDermott+Consulting.

Webinar: Utilizing Vatica Telehealth to Supercharge Your Practice in COVID-19

Providers, hear from the Vatica team and 2 PCPs successfully utilizing telehealth to keep their practices running in COVID-19.  We'll also share some practical tips on implementing Vatica Health's telehealth solution.


Blog: COVID-19 Primary Care Challenges and Opportunities

For PCPs, particularly those who serve seniors, the virus presents some challenges: routine care isn't happening, volume and revenue are down, and offices are short-staffed. But, there is a path forward. 

 Blog: The Impact of Telehealth on Risk Adjustment

 Rolling out telehealth isn’t as simple as flipping a switch. During this period of transition, health plans should recognize the new challenges PCPs face and support them in continuing to provide care to their patients.

Frequently Asked Questions

  1. Do telehealth visits count for gathering risk adjustment data?
    On April 10, 2020, CMS announced that Medicare Advantage organizations and other at-risk entities are able to submit diagnoses for risk adjustment from telehealth visits.

  2. How quickly can Vatica Health implement telehealth solutions for payers and providers?
    Today! We began augmenting our solution when CMS initially announced the expansion of telehealth services in early March, and we are ready to support you. We’ve already enabled our clients to deliver a fully compliant and effective risk adjustment encounter via telehealth.

  3. What differentiates Vatica Health?  
    Unlike other risk adjustment vendors, Vatica is PCP-centric and offers clinical and administrative support to providers. We offer hands-on virtual support and help providers implement our solution and drive member engagement.

  4. Why is a PCP-centric approach to risk adjustment important?
    For several reasons. First, PCPs need help. They are under severe strain and need help generating reimbursable revenue and connecting with their patients. Second, neither patients nor PCPs want an encounter performed by an independent clinician. Third, our connection to the EMR ensures all appropriate clinical information is considered and that care gaps can be addressed.

  5. What about retrospective chart reviews?  
    While the traditional method of chart reviews is not feasible given the closure of most PCPs’ offices, our Vatica Clinical Consultants are embedded within PCPs and connected to EMRs, enabling us to perform remote retrospective chart reviews.

  6. Is telehealth for risk adjustment here to stay?
    We are cautiously optimistic. Telehealth will never fully replace in-person care, but it’s an important and overdue expansion of services for Medicare beneficiaries that is likely to continue after the end of the public health crisis. This is critical since seniors are at the greatest risk of complications from COVID-19, and there is no visibility into a vaccine or effective treatment. If telehealth remains in place for routine and preventive care, we expect CMS’ new guidance on risk adjustment via telehealth to also be extended.

  7. What are your next steps?
    Please contact Vatica Health to learn about our unique PCP-centric telehealth solution. We will be in touch within 24 hours.