Risk Adjustment & Coding

Synthesis:

In the last 24 hours, CMS has proposed a nationwide expansion of a mandatory joint replacement bundled payment model (CJR-X), signaling a renewed federal push toward value-driven reimbursement structures and sharpening the focus on risk adjustment and coding accuracy for affected providers and ACOs. Simultaneously, new analysis highlights significant risks for 2027 LEAD model participants, pinpointing persistent data and coding gaps that could materially impact participant performance and financial outcomes—intensifying the need for robust coding, risk stratification, and population health management infrastructure in advance of further mandatory models and evolving VBC requirements. See details on the CJR-X proposal and LEAD model risks.