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As CMS continues to refine Medicare Advantage and Part D, the proposed changes signal a broader shift toward documentation integrity, defensible reimbursement, and accountability that extends well beyond any single program or model. While much of the attention will focus on Star Ratings and risk adjustment, the underlying message is more fundamental: documentation must accurately reflect clinical reality and support the care delivered consistently, longitudinally, and complia

So much of healthcare performance comes down to one simple truth: Your clinical data is only as accurate as the specificity behind it.   Across Medicare Advantage, ACOs, Medicaid Managed Care, and Commercial Exchange plans, risk adjustment is a core driver of reimbursement, resource allocation, and care strategy. And in every one of these models, accurate patient risk scores depend on the level of specificity in documentation and coding.   Every day, diagnoses flow into EMRs

CMS-HCC Version 28 (V28) will take full effect starting January, marking the completion of the three-year phase-in from V24. In 2026 (payment year), 100% of Medicare Advantage risk scores will be calculated using V28, based on 2025 dates of service. This means tighter clinical documentation requirements, the permanent removal of commonly reported Hierarchical Condition Categories (HCCs), and even greater scrutiny on how chronic conditions are monitored, evaluated, assessed, a