External Audit Finds 97% of UnitedHealth HouseCalls Diagnoses Supported by Medical Records
An external audit of UnitedHealth's HouseCalls program found that nearly 97% of diagnoses identified during senior home visits were supported by patients' medical records. The audit was conducted amid scrutiny of home visit programs used to identify conditions for Medicare Advantage risk adjustment. UnitedHealth released the findings to validate the program's integrity following questions about diagnosis coding practices in home-based assessments. The results address ongoing concerns from regulators and policymakers about the accuracy of diagnosis reporting in value-based care arrangements.
The audit findings are relevant to Medicaid managed care organizations operating similar home-based assessment programs or considering value-based payment models that rely on accurate diagnosis coding and risk adjustment methodologies.
Managed Care
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