Medicare Advantage Risk Adjustment Modernization: Preparing for CMS-HCC Model V28
CMS-HCC Model V28 introduces the most significant changes to Medicare Advantage risk adjustment in a decade — reshaping condition categories, diagnostic hierarchies, and the coefficients that drive plan payment. Health plans navigating blended model years through 2025 must ensure accurate data, aligned systems, and reliable forecasting to avoid compliance gaps and revenue disruption.
3-Year Transition
Blended model years extend through CY 2025
Major Model Overhaul
Diagnostic hierarchies and coefficients recalibrated.
Why V28 demands more than a technical update
For many Medicare Advantage plans, V28 readiness cannot be solved by updating mapping logic alone. The model redesign requires coordinated alignment across data engineering, compliance, finance, actuarial, and operational teams — each of whom depends on accurate, consistent, and timely data to perform.
Without that alignment, plans face:
The result is predictable: delayed transitions, inaccurate submissions, and uncertainty in payment projections.
At a glance
What you'll learn in the white paper
"Our clients have seen up to a 40% reduction in implementation rework by aligning teams early."
- Ronny Neira, Chief Services Officer, MHC Services Group
Get the white paper: Preparing for CMS-HCC Model V28
A clear, practical guide to understanding the impact of V28 — and what health plans must modernize to achieve data integrity, forecasting precision, and long-term regulatory readiness.