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A Revenue Integrity Series I Paper No. 3 A policy change buried in CMS's April 6, 2026, Calendar Year 2027 Medicare Advantage Rate Announcement carries one of the most consequential revenue implications for MA plans in recent memory - and most organizations have not yet begun to respond to it. Beginning in Calendar Year 2027, CMS is finalizing the exclusion of diagnoses derived from unlinked chart review records (CRRs) from risk score calculations. In plain language: if you

A Revenue Integrity Series I Paper No. 2 If your Medicare Advantage plan has not yet begun preparing for a Risk Adjustment Data Validation (RADV) audit, the clock is no longer just ticking - it is running. CMS has fundamentally transformed its audit program, and 2025 and 2026 represent the most consequential compliance period in the history of Medicare Advantage risk adjustment. This is not a drill. It is not a warning of something that might happen. It is already underway. W

A Revenue Integrity Series I Paper No.1 For ACA marketplace health plans, the period between May and August is what we call the Blackout Period: the interval between the close of open enrollment and the beginning of the next plan year's data submission cycle. Most plans treat this time as an administrative lull. The most sophisticated ones treat it as their single most valuable operational window. Here is our insider tip: what you do - or don't do - between May and August