Introduction: V28 raises the bar on recapture
CMS‑HCC V28 is fully in effect for payment year 2026, and it makes annual recapture more important than ever.
The RAF reset each January means prior‑year documentation cannot carry forward.
1. What changed in V28
V28 removed and re‑mapped thousands of codes and tightened the relationships between conditions.
That means accurate specificity and current‑year support matter even more.
2. The annual reset is the rule, not the exception
A condition documented last year does not count this year unless it is addressed again in a face‑to‑face encounter.
This is the core reason most RAF drift happens in risk‑bearing organizations.
3. What must be re‑documented
Chronic conditions that drive RAF should be re‑documented at least once per calendar year with MEAT support.
The goal is not volume. It is defensibility and continuity.
4. Prioritize by impact and likelihood to drop
Start with conditions that are both high‑impact and historically under‑supported.
Use prior‑year HCC lists to seed a focused redoc queue rather than broad chart review.
5. Keep evidence encounter‑linked
MEAT support must be explicit, current‑year, and tied to a face‑to‑face encounter.
Problem lists and inference do not pass review.
6. Build a year‑round cadence
Recapture should be a steady rhythm, not a Q4 scramble.
A quarterly cadence makes continuity visible and reduces late‑year surprises.
7. Measure what matters
Track recapture rate, continuity coverage, MEAT completeness, and modeled revenue impact.
These metrics connect documentation quality directly to RAF stability.
CTA
If V28 recapture feels bigger than your current workflow, it probably is.
A focused playbook brings it back under control.
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