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The transition to CMS V28 is more than a coding update—it’s a shift that challenges health plans to rethink their operational strategies, documentation standards, and compliance frameworks. With increased specificity requirements and restructured HCC groupings, the ability to adapt quickly has become a competitive advantage. For many organizations, success in this environment depends on how effectively they collaborate with Risk Adjustment Vendors who bring both expertise and adaptability to the table.
Under V28, certain conditions that once carried weight may no longer contribute to risk scores, while others now demand more detailed documentation to remain valid. This evolution requires providers to document with precision and coders to interpret with greater accuracy. Health plans cannot shoulder this transition alone; they need vendors who understand the technical requirements while also helping providers adjust workflows at the point of care.
The days of treating vendors as transactional coding services are over. Health plans must now view vendors as strategic partners capable of:
Providing continuous education to providers and coders on V28-specific documentation changes.
Offering technology-enabled tools that flag missing specificity in real time.
Conducting retrospective reviews that align with new CMS criteria.
Delivering transparent reporting that highlights both performance gains and compliance risks.
This broader role positions vendors not just as service providers but as key contributors to audit readiness, revenue stability, and long-term success under V28.
The best partnerships strike a balance between automation and expertise. AI-powered platforms can identify documentation gaps or coding inconsistencies, but it’s experienced coding professionals who interpret context and ensure defensibility. Vendors who integrate both seamlessly help health plans scale while maintaining compliance.
Vendor partnerships also play a vital role in bridging the gap between health plans and providers. By creating feedback loops, vendors can relay insights from coding reviews back to clinicians, turning documentation improvements into daily habits rather than audit-season corrections. This shared accountability ensures that V28’s stricter requirements don’t become bottlenecks but opportunities to strengthen care documentation overall.
CMS V28 is reshaping the risk adjustment landscape, and health plans cannot navigate it alone. Redefining partnerships with Risk Adjustment Vendors ensures that organizations are equipped with the education, technology, and compliance support they need to succeed. By choosing vendors who act as true allies, health plans can turn the challenges of V28 into opportunities for accuracy, audit readiness, and sustainable growth.
