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Proposed CMS regulations call for a prospective risk adjustment solution with PCP involvement
CMS continues to intensify oversight of Medicare Advantage (MA) risk adjustment practices with the 2027 Advance Notice, significantly curtailing the use of retrospective risk adjustment diagnoses that are not supported by a qualifying patient encounter. This latest policy direction reflects a broader multi-year regulatory trend aimed at strengthening program integrity, tightening documentation standards, and reinforcing encounter-based risk adjustment accuracy.
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