Risk Adjustment & Coding

Risk adjustment and coding activity is centering on two pressure points for VBC organizations: tighter post-payment scrutiny and the operational challenge of documenting legitimate complexity without triggering audit exposure. A new payer-complexity analysis points to growing post-payment risk for providers and MA/VBC entities, while AMGA’s contracting-focused guidance underscores the need for tighter payer-provider collaboration around documentation, attribution, and outcome measurement in value-based contracts (Modern Healthcare, AMGA). At the same time, evidence that Medicare Advantage disenrollment rises with each additional complex diagnosis raises a strategic red flag for plans and risk-bearing providers: RAF accuracy, care management intensity, and member retention are increasingly linked, especially for high-acuity populations.