A recent report by The Wall Street Journal highlights that Medicare is issuing additional payments for home visits tied to patient diagnoses. This practice aims to incentivize thorough patient evaluations but has implications for insurers managing Medicare Advantage plans.
Financial Implications
Insurers must account for the increased costs associated with these extra payments. The adjustment could lead to higher premiums or shifts in coverage options as insurers seek to balance these new expenses.
Risk Adjustment Models
The changes may prompt insurers to refine their risk adjustment models. Accurately capturing patient health statuses through home visits could impact reimbursement rates and overall financial planning.
Regulatory Scrutiny
With increased payments, insurers might face greater regulatory scrutiny to ensure compliance and prevent potential abuses. Insurers will need to maintain rigorous oversight to align with Medicare guidelines.