Revenue Cycle & Payment Integrity

Synthesis: Over the last 30 days, CMS has intensified its push toward mandatory value-based payment models, with the newly released FY27 proposed rule expanding the Comprehensive Care for Joint Replacement (CJR) bundled payment model to nearly all hospitals nationwide—a structural shift signaling federal commitment to mainstreaming episodic payments for inpatient services (HFMA coverage). Simultaneously, finalized changes to the 2027 Part D risk adjustment methodology are set to substantially alter MA-PD and PDP plan payments, underscoring a broader move toward risk alignment, data-driven accountability, and payment integrity as CMS deploys regulatory incentives and technology—including AI—for more precise oversight (Avalere analysis). These developments create urgency for health systems, ACOs, and MA plans to strengthen data management, contract strategies, and population health infrastructure to mitigate risk and capitalize on the accelerating value-based care transition.