Right now, every risk adjustment team in the country is staring at the same impossible list:
- 2025 retrospective chart reviews
- RADV audit prep
- ACA EDGE submissions deadline
- ACA RADV response
- Unlinked claim remediation
- 2027 Advance Notice prep
- 2027 bid development
And that’s before the day-to-day — provider education, data reconciliation, vendor management, analytics requests.
So how does it all get done?
It doesn’t. Not all of it. Not well. Not without making hard tradeoffs.
The teams I’ve worked with that actually stay ahead have one thing in common: they know which 20% of the work drives 80% of the results — and they ruthlessly prioritize.
That means knowing exactly where your encounter data is leaking. Which provider programs are actually moving risk scores. Which RADV prep items are audit-critical vs. nice-to-have.
Most teams don’t have the bandwidth to step back and assess that. They’re too busy executing.
That’s where I come in. A fresh set of eyes, over a decade deep in this work, helping you figure out what to focus on — and what to stop doing.
If your RA team is stretched thin and the list keeps growing, let’s talk.
If your team is staring at its own impossible list, we can help you find the 20% of work that actually moves your risk scores this performance year.
More Articles
I Tried to Break OIG’s $462 Million Stroke Finding. Here’s Why I Couldn’t.
OIG says CMS overpaid Medicare Advantage plans $462M on unsupported acute stroke codes. I tried to break the methodology the way a plan's lawyers would — here's why it holds, and the one habit underneath it.
Risk Adjustment Is a Data Management Exercise — Get Ready for the LEAD Model
With CMS's LEAD model arriving in 2028, organizations that treat data as an afterthought will face revenue volatility, benchmark surprises, and competitive disadvantage. Two priorities to fix it now.
CMS 2027 Final Notice: Unlinked Chart Reviews Will Be Accepted
CMS's 2027 Final Notice changes course on unlinked chart review for members changing plans, and lands a 2.48% pre-RA rate increase.
Need this type of outcome in your organization?
Book a consultation to discuss your goals, current blockers, and where we can create the fastest measurable impact.