#medicareadvantage

Repost @cjnlegalnurse: Aetna is cutting nearly 90 Medicare plans across 34 states in 2026. Millions could lose coverage. This is HUGE—and no one’s talking about it.

Stop overfunding Medicare Advantage!

597 so far! Help us get to 1,000 signers!

At tremendous cost to taxpayers and people with Medicare, the government has overpaid Medicare Advantage plans tens of billions of dollars for more than a decade and is projected to overpay them more than $1 trillion in the next decade. Just as the government recoups overpayments to individuals it should be recouping Medicare Advantage overpayments, not rewarding them with greater revenues. In addition to driving up costs for everyone with Medicare, it is eroding the Medicare Trust Fund. I urge you to reduce MA rates to a level commensurate with Traditional Medicare and recoup all overpayments. Thanks!

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The calculator is for the moment a coder is looking at one chart. Pick the model — V28, V24, RxHCC, ESRD, CMMI-HCC — pick the risk factor, drop in up to 20 ICD-10 codes, and out comes a revenue impact report with V24 and V28 side by side and the MA payment spelled out. PDF it, attach it to the query, move on.

It answers: what is this patient worth, and what did documentation miss?

The API is for the moment nobody is looking at anything. It sits inside the EMR, the population health platform, the risk capture tool, and scores the whole panel while everyone sleeps. Potential, cumulative, delta.

It answers: which 1,000 of these 40,000 patients should a human open tomorrow?

The failure mode that shows up most often: a team buys the second problem's solution for the first problem, or spends a year doing the API's job by hand in the calculator.

One chart at a time is a coder's tool. Forty thousand charts is an integration.

Figure out which question is actually being asked. Then pick the door.

🔗 Full breakdown of when each one wins → RAF Score Calculator vs API

🔗 If the interactive route is the one → the RAF score calculator decomposes a member's score on the spot.

Free tier on the calculator, free trial on the API.

Stat that reframes the whole conversation:

In most Medicare Advantage populations, a small slice of members drives a hugely disproportionate share of cost. Risk stratification is how you find that slice before the costs land — sorting members by acuity so care management goes where it actually moves the needle.

The data backbone for that sorting is the same machinery behind funding accuracy: HCCs, RAF, CMS-HCC V28. Stratification just points it forward instead of backward.

Want to see it in practice? This medicare advantage risk adjustment case study walks through how a plan turned risk data into a prioritized outreach list (synthetic figures, real workflow).

Full data guide here → Medicare Advantage Risk Stratification

TL;DR — a RAF score tells you the past. Stratification tells you who to call tomorrow.

VBC Risk Analytics. Educational only — not coding, billing, or clinical advice; verify against the current CMS Rate Announcement. Synthetic data only.

Underrated truth in risk adjustment:

A good clinical documentation improvement program isn't a cost center — it's one of the few functions that touches revenue, quality scores, AND audit defense at the same time. The problem is nobody department ever sees the whole return, so it gets undervalued in budget season.

The fix is boring but powerful: build a baseline, attribute RAF lift only where the clinical evidence supports it, then add the denials and RADV findings you avoided. Count it the same way you'd defend it.

Illustrative math (synthetic): document a few hundred previously-missed-but-supported conditions in a year and the conservative per-member revenue impact tends to clear program cost several times over — while strengthening your audit posture instead of weakening it.

Rule of thumb: if you can't show the evidence, don't count the dollars.

Full measurement playbook → CDI Program ROI.

VBC Risk Analytics. Educational only — not coding, billing, or clinical advice; verify against the current CMS Rate Announcement. Synthetic data only.

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