CMS Moves Toward Modernizing Medicare Risk Adjustment to Reduce Clinician Burden

HMP Global November 7, 2025
Hannah Musick

Key Clinical Summary

• Administrative strain: Current risk adjustment methods relying on diagnosis coding from claims contribute to physician burnout and potential payment bias.
• Policy reform: CMS’s risk-adjustment version 28 reduces coding incentives but may inadvertently disincentivize early disease detection and management.
• Next steps: CMS aims to integrate interoperable electronic health data to improve payment accuracy, reduce documentation workload, and advance value-based care.

Efforts by the Centers for Medicare & Medicaid Services (CMS) to modernize Medicare’s risk-adjustment system are reshaping how clinicians are paid for value-based care. According to a recent policy analysis, ongoing reforms seek to balance accuracy, reduce administrative burden, and enhance equity in payments across Medicare Advantage (MA) and traditional Medicare accountable care programs.

Study Findings...

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