Navigating the Mandatory Transition to CMS-HCC Model V28

The transition from V24 to V28 has been in the works since 2023. While it’s old news for most risk groups, the completed conversion in 2026 is likely to decrease risk-adjusted payments. Navigating this mandatory transition requires a proactive approach to auditing, coding accuracy, and data analysis to ensure preparedness for the 2026 implementation and beyond.

Changes with V28

To thrive in this new environment, understanding the key changes and implementing robust strategies for documentation and data submission is paramount for accurate reimbursements and providing quality care under the V28 model. The transition to V28 exclusively includes:

• An overall increase in Hierarchical Chronic Condition (HCC) categories from 86 to 115.
• Elimination of or renumbering for some HCCs.
• New categories built around ICD-10-CM codes, using the clinical concepts in that system.
• Removal of assigned risk scores from 2,264 diagnosis codes.
• Decreased values for some commonly reported conditions, like diabetes.

How Software Can Help

While coders and clinical documentation improvement teams focus on V28 requirements, providers should review the practices needed to support accurate coding during wellness visits and other clinical appointments. Consider a solution that:

• Displays current HCC codes with explicitly documented, captured, and missing diagnosis codes per member.
• Highlights HCCs missing from the current payment year for which a member is eligible based on documented diagnosis codes.
• Offers downloadable member-level reports for payers to share with providers as prompts to close gaps.
• Links to member claims, with visibility to captured and coded diagnoses.

Identify Discrepancies with RAMP by FRG

Manage the risk adjustment model transition with minimal disruption while maximizing revenue. RAMP by FRG supports HCC code validation and documentation across CMS risk adjustment models, ensuring accurate reflection of member risk.

RAMP analytics are also paired with documentation detail not available through any other solutions partner, enabling users to take immediate action. RAMP helps FRG clients reconcile medical expense budgets with real panel acuity.

To learn more about FRG and how RAMP can set your organization on a path to achieving accurate risk adjustment and risk scores while using the V28 model, contact us today.