Medicare Advantage is entering one of its most consequential periods of change. The full transition to the HCC V28 risk adjustment model is now complete, CMS audit oversight is expanding amid ongoing legal uncertainty around RADV extrapolation methodology, prior authorization protections have been suspended, and major health systems and insurers alike are reassessing their MA participation - marking the first decline in MA enrollment in over a decade. Recent CMS regulatory reversals are creating new planning uncertainty for every organization that contracts with, operates within, or advises on Medicare Advantage plans. Reactive or siloed approaches are no longer sufficient.

This webinar is designed to help providers, revenue cycle teams, compliance professionals, healthcare attorneys, and healthcare leaders build a current, practical understanding of Medicare Advantage coding compliance, audit risk, and revenue protection across 2025–2027. We will cover key CMS policy signals and regulatory reversals shaping the landscape, insurer and health system withdrawal trends, documentation and coding requirements now fully in effect under the V28 model, RADV audit risk in an uncertain legal environment, and revenue cycle strategies to protect compliant reimbursement. Whether you manage Medicare Advantage performance daily, advise provider organizations on compliance and reimbursement, or oversee financial and operational strategy — this session delivers clear, actionable guidance you can apply immediately within your existing workflows.

Webinar Objectives

Medicare Advantage changes across 2025–2027 are increasing complexity for providers, revenue teams, compliance leaders, and the advisors who serve them. This session is designed to help participants achieve the following outcomes:

• Gain clarity on how Medicare Advantage policy, payment, and oversight changes - including recent CMS regulatory reversals - will impact providers through 2027
• Interpret CMS Advance Notices as forward-looking planning tools and understand how they influence payer behavior, network decisions, and downstream provider risk
• Protect coding compliance under the fully implemented HCC V28 model by identifying which documentation and coding workflows need to be updated to avoid revenue loss
• Defend against RADV audit exposure in an uncertain regulatory environment - understanding the current legal landscape and what documentation standards must be in place regardless of how the courts rule
• Secure revenue under tighter utilization management and prior authorization pressure, including the operational impact of suspended prior authorization oversight regulations
• Strengthen internal alignment between documentation, coding, billing, and compliance functions around a shared MA performance framework
• Leave with a clear 90-day action framework to support coding compliance, audit readiness, and revenue protection starting immediately

Webinar Agenda

During this session, participants will explore the following topics:

• Medicare Advantage policy and payment direction shaping the 2025–2027 landscape - including CMS regulatory reversals, the suspended prior authorization oversight rules, and what the current administration's policy shifts mean for providers
• Key insights from recent and upcoming Medicare Advantage Advance Notices, including how to translate the CY 2027 Advance Notice and the April 2026 Rate Announcement timeline into operational planning decisions
• Insurer and health system responses to CMS signals - including plan withdrawals, health system contract terminations, network changes, and operational guidance for providers when a contracted plan exits their market
• Coding compliance requirements under the fully implemented HCC V28 model - covering Diabetes subtypes, CKD staging, CHF specificity, BMI capture, and the 2027 shift away from unlinked chart review diagnoses
• Revenue cycle considerations under tighter utilization management and prior authorization - including the impact of suspended prior auth regulations and how to build denial-resistant, payer-specific workflows
• Medicare Advantage audit focus areas including RADV mechanics, the ongoing federal court challenge to CMS extrapolation methodology, and the documentation standards providers must maintain regardless of how the legal uncertainty resolves
• Operational planning considerations ahead of open enrollment and multi-year contract cycles - including D-SNP and Special Needs Plan growth trends and the MA planning calendar through 2027
• Practical strategies to improve coordination across revenue, compliance, and operational teams - including a ready-to-use 90-day action framework covering gap assessment, coding updates, denial tracking, and audit preparation

Webinar Highlights

• A current, comprehensive overview of Medicare Advantage coding compliance, audit risk, and revenue protection spanning 2025, 2026, and 2027 - grounded in the latest CMS guidance and regulatory developments
• Coverage of CMS Advance Notices and the 2027 Rate Announcement timeline, and how to use them as forward-looking planning tools before they become final
• Practical coding guidance now fully in effect under HCC V28 - and what the 2027 unlinked chart review exclusion means for documentation and coding workflows today
• A clear-eyed assessment of RADV audit risk in 2026 - covering both the operational exposure and the ongoing legal challenge - so your organization can prepare intelligently regardless of how the courts rule
• Revenue cycle strategies to protect reimbursement amid suspended prior authorization protections, rising denial volumes, and increasing insurer and health system contract instability
• Actionable steps to take before open enrollment and contract renewal cycles, including how to respond operationally when an insurer exits your market or a health system drops MA participation
• A 90-day action framework you can apply immediately within your existing workflows - no new budget or systems required

Who Should Attend

• Revenue Cycle Managers & Directors
• Medical Coding & HCC Documentation Specialists
• Billing & Reimbursement Professionals
• Medical Auditing Specialists
• Managed Care & Contracting Professionals
• Practice Administrators
• Operations and Finance Leaders
• Compliance Officers & Compliance Committees
• Physicians and Clinical Leaders involved in documentation oversight
• Healthcare Attorneys advising providers on MA compliance and reimbursement
• Healthcare Consultants supporting revenue cycle or compliance engagements
• Healthcare CPAs & Financial Advisors modeling MA revenue impact