Revenue Cycle & Payment Integrity

Synthesis:

Over the past week, CMS released the FY27 proposed rule that would make the Comprehensive Care for Joint Replacement (CJR) bundled payment model mandatory for nearly all hospitals nationwide, marking a significant escalation in the shift toward value-based reimbursement and increasing the pressure for hospitals to optimize revenue cycle and payment integrity processes. Simultaneously, finalized changes to the 2027 Medicare Advantage and Part D risk adjustment methodologies are set to alter plan payments, further redefining incentives for accurate coding, data management, and contract oversight for payers and providers. Ongoing discussion of payment reform—including California's multipayer primary care payment initiative and calls for robust data-driven strategies—demonstrate the complex realignment of stakeholders as value-based care models become more ambitious and administratively demanding. For further detail, see HFMA's coverage on the CMS FY27 inpatient rule and Avalere's analysis of 2027 Part D risk adjustment changes.