In 2026, CMS-HCC Model V28 is now fully in effect, RADV audits are accelerating, and the OIG is actively flagging unsupported diagnosis codes across Medicare Advantage plans. Yet despite the heightened regulatory environment, many organizations continue making the same risk adjustment mistakes that cost them revenue, trigger audits, and damage long-term compliance standing. At HealthSpective, we have worked with health plans, provider groups, and managed care organizations si

See just a few of the reasons why HealthSpective should be your go to partner for healthcare management expertise. Click here to learn more about who we serve.

For more than three decades, HealthSpective has grown alongside the healthcare industry. What began with HEDIS compliance and healthcare informatics, has evolved into a trusted partner for data validation, accreditation support, risk adjustment and healthcare consulting. Our journey reflects an ongoing commitment to quality, innovation, and integrity. Today, our team of experts helps healthcare organizations make confident data driven decisions that improve performance and ou

Accurate risk adjustment reflects the true health status of your patients, supports quality care, and ensures proper reimbursement. Whether you are managing a health plan, working within a clinical setting, or partnering with a healthcare management consulting firm, getting risk adjustment right is not optional it is foundational. As we move through 2026, the stakes around accurate medical coding continue to rise. CMS audits are more frequent, HCC model updates demand ongoing