Medicare Advantage is entering one of its most consequential periods of change. The full transition to the HCC V28 risk adjustment model is now complete, CMS audit oversight is expanding amid ongoing legal uncertainty around RADV extrapolation methodology, prior authorization protections have been suspended, and major health systems and insurers alike are reassessing their MA participation – marking the first decline in MA enrollment in over a decade. Recent CMS regulatory reversals are creating new planning uncertainty for every organization that contracts with, operates within, or advises on Medicare Advantage plans. Reactive or siloed approaches are no longer sufficient.
This webinar is designed to help providers, revenue cycle teams, compliance professionals, healthcare attorneys, and healthcare leaders build a current, practical understanding of Medicare Advantage coding compliance, audit risk, and revenue protection across 2025–2027. We will cover key CMS policy signals and regulatory reversals shaping the landscape, insurer and health system withdrawal trends, documentation and coding requirements now fully in effect under the V28 model, RADV audit risk in an uncertain legal environment, and revenue cycle strategies to protect compliant reimbursement. Whether you manage Medicare Advantage performance daily, advise provider organizations on compliance and reimbursement, or oversee financial and operational strategy — this session delivers clear, actionable guidance you can apply immediately within your existing workflows.
• A current, comprehensive overview of Medicare Advantage coding compliance, audit risk, and revenue protection spanning 2025, 2026, and 2027 – grounded in the latest CMS guidance and regulatory developments
• Coverage of CMS Advance Notices and the 2027 Rate Announcement timeline, and how to use them as forward-looking planning tools before they become final
• Practical coding guidance now fully in effect under HCC V28 – and what the 2027 unlinked chart review exclusion means for documentation and coding workflows today
• A clear-eyed assessment of RADV audit risk in 2026 – covering both the operational exposure and the ongoing legal challenge – so your organization can prepare intelligently regardless of how the courts rule
• Revenue cycle strategies to protect reimbursement amid suspended prior authorization protections, rising denial volumes, and increasing insurer and health system contract instability
• Actionable steps to take before open enrollment and contract renewal cycles, including how to respond operationally when an insurer exits your market or a health system drops MA participation
• A 90-day action framework you can apply immediately within your existing workflows – no new budget or systems required
R. Sharma, is a seasoned healthcare professional with over 20 years of clinical and operational experience. As a registered nurse and midwife, his deep clinical foundation spans hands-on patient care, health information management, revenue cycle management, and health technology systems. He has held various leadership roles across both outpatient and inpatient settings, and was responsible for managing large-scale operations for one of the top 10 hospital groups in the United States. He brings a unique, frontline-informed perspective to discussions on healthcare delivery, operational efficiency, and technology integration.