Preparing for the next phase of CMS risk adjustment oversight

CMS continues to intensify scrutiny of Medicare Advantage risk adjustment, with the 2027 Final Notice further limiting the use of retrospective diagnoses that are not supported by a qualifying patient encounter. These changes reflect a broader shift toward stricter documentation standards, greater accountability, and a renewed emphasis on accuracy at the point of care.

The risk adjustment regulatory landscape is shifting

In this whitepaper, we break down what’s changing, what it means for your organization, and how to adapt your strategy to stay compliant while protecting performance.

A prospective solution that offers more value

Vatica Health — together with Cozeva, our new merger partner — offers provider-centric solutions that enable health plans to capture more member data, foster greater payer-provider collaboration and advance value-based care enablement. By combining our highly trained clinical teams with Cozeva’s premier VBC platform, health plans can optimize member and financial outcomes at the point of care in a way that suits them best. And our solutions can be implemented well in advance of any new regulations in 2027.

“We’ve advocated that one of our other large payers in the community partner with Vatica so we can use the solution for more of our patients. We’d like to see all the payers in our marketplace use Vatica and look forward to leveraging Vatica as we transition to more value-based care. Our group is very appreciative of Vatica’s efforts, partnership and collaboration.”

— Richard Charles, MD, General Physician PC, New York

“Vatica has been a great resource with ICD-10 coding, helping us get to a level of specificity that most physicians don’t have the coding experience for.”

— Anthony Rizzo, DO, Family Medicine Physician, Mercyhealth

“Having this detail helps me to document and code as accurately as possible, which directly factors into capitation rates for these patients. Receiving appropriate capitation makes a big difference to my practice. And the incentive we receive for each completed Annual Wellness Visit has a huge impact on our financials.”

— Paul Linder, MD, Internal Medicine Physician, Paul G. Linder and Associates

Preparing for the next phase of CMS risk adjustment oversight

The risk adjustment regulatory landscape is shifting

Some perspective on prospective risk adjustment

A prospective solution that offers more value

Vatica + Cozeva = value

Ensures compliance, reduces audit risk

Activate your providers

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