Training Clinical Teams on V28 Risk Adjustment and Claims Pricing in 30 Days

With CMS implementing the Version 28 (V28) update to its Hierarchical Condition Category (HCC) risk adjustment model, healthcare organizations face an urgent need to re-educate their clinical and coding teams. Unlike previous iterations, V28 introduces significant changes to HCC categories, removes over 2,000 ICD-10 codes, and shifts Medicare Advantage reimbursement to a more granular and transparent data system.

The pressure to stay compliant—and financially whole—is intense. Yet, many organizations struggle to operationalize these updates quickly across their teams. This blog outlines a strategic 30-day training blueprint to help provider groups, ACOs, and health systems upskill their teams fast—without sacrificing accuracy or workflow integrity.

📚 Why V28 Training Is Non-Negotiable

CMS's V28 transition is more than just an ICD-10 mapping update. It's a foundational shift in how patient risk is captured and how reimbursement is calculated.

Key changes in V28:

• Deactivation of codes previously mapped to HCCs (e.g., common pain codes like M54.5)

• More emphasis on chronic condition severity

• 100% transition to encounter data by 2026

• Stricter audit scrutiny under Medicare Advantage
  

Failure to train clinical teams leads to:

• Lower RAF (Risk Adjustment Factor) scores

• Revenue loss

• Compliance risks from incorrect documentation

• Poor performance on quality measures
  

📅 Week-by-Week Training Framework

Week 1: V28 Fundamentals + Communication Plan

Goals:

• Align leadership, coding, and clinical teams on the importance of V28

• Communicate the impact of changes on revenue and compliance

Tactics:

• Host a kickoff webinar with your compliance and finance leaders

• Distribute a V28 overview handout summarizing key changes

• Begin collecting questions and pain points via anonymous form

Resources:

• CMS V28 technical documentation

• Organization-specific financial impact analysis
  

Week 2: Clinical and Coding Deep Dive Goals:

• Equip clinicians and coders with V28-specific documentation and coding standards

Tactics:

• Create micro-training modules:

  • Module 1: What’s changed from V24 to V28?

  • Module 2: MEAT criteria (Monitor, Evaluate, Assess, Treat)

  • Module 3: Coding specificity for chronic conditions (e.g., Diabetes, CHF, CKD)

• Live case coding reviews in team huddles

  
  

Key Metrics:

• Pre- and post-training quiz scores

• Coding accuracy audit baseline
  

Week 3: Documentation Audits + EHR Optimization Goals:

• Validate documentation compliance

• Ensure your EHR templates and prompts align with V28

Tactics:

• Conduct random chart audits focused on:

  • Unsupported diagnoses

  • Vague ICD-10 usage

  • Missed chronic conditions

• Collaborate with EHR vendors to:

  • Remove deprecated codes from dropdowns

  • Add prompts for HCC-eligible conditions

  • Enable MEAT criteria reminders

    
    

Deliverables:

• Audit scorecard template

• List of necessary EHR updates
  

Week 4: Simulation + Policy Updates Goals:

• Solidify real-world application of new coding standards

• Formalize V28 policies into compliance documentation

Tactics:

• Run mock documentation-to-coding simulations:

  • Provide clinicians with real scenarios and patient histories

  • Assign coders to extract compliant diagnoses

• Finalize updated internal policies and share across departments

• Provide a digital V28 checklist tool for clinicians

Celebrate Progress:

• Highlight coding wins in staff meetings

• Award badges or recognition for top-performing staff
  

🛠️ V28 Compliance Toolkit Essentials

Equip your team with the right tools:

• ✅ Updated ICD-10-to-HCC crosswalk (V28-specific)

• ✅ MEAT documentation tip sheets

• ✅ Annual diagnosis refresh checklist

• ✅ Coding audit templates

• ✅ EHR user guides with V28 triggers
  

🔄 Post-Training: Monitor, Adapt, Repeat

The 30-day sprint is just the beginning. After rollout:

• Conduct monthly audits

• Monitor RAF score changes

• Survey staff for ongoing gaps

• Provide refreshers quarterly or during onboarding

  
  

  Bonus Tip: Collaborate with Medicare Advantage Organizations (MAOs) to align on data quality expectations and coding standards.
  

💭 Final Thoughts

Training your clinical team on V28 risk adjustment in just 30 days is achievable with the right structure, communication, and resources. By investing in short-term training now, providers set themselves up for long-term reimbursement accuracy, audit success, and clinical quality.

Remember: CMS isn't just looking for diagnoses. They want documentation that reflects real, actionable care. Take The Next Step—Reach Out To Us To Ensure V28 Readiness!