Project Overview Interactive Power BI dashboard comparing the impact of the new CMS-HCC V28 risk adjustment model against the previous V24 model. This analysis focuses on how the updated coefficients affect Risk Adjustment Factor (RAF) scores across major chronic conditions.
Note: All projects are built using synthetic data for portfolio and learning purposes only. No real patient data or actual organizational data was used.
Key Findings
- The new V28 model shows lower average RAF scores compared to V24 across most major chronic conditions.
- Lung Cancer and Crohn’s Disease remain major RAF drivers under both models.
- Accurate and complete documentation continues to be critical for proper risk adjustment and reimbursement.
- Several chronic conditions may require updated coding and documentation practices under the new model.
Recommendations
- Prioritize coder and provider education on V28-specific documentation requirements.
- Conduct internal audits to identify conditions most affected by the model change.
- Update risk adjustment strategies and HCC capture processes to align with V28 coefficients.
- Monitor financial impact closely during the transition period to minimize revenue gaps.
- Focus on high-RAF conditions (e.g., Lung Cancer, Crohn’s Disease) to ensure accurate coding and documentation.
Key Features
- Side-by-side comparison of V24 and V28 RAF scores
- Identification of high-impact chronic conditions (e.g., Diabetes, CHF, COPD, etc.)
- Analysis of potential reimbursement and documentation implications
- Risk prioritization for Medicare Advantage compliance
Skills Demonstrated
- Advanced understanding of CMS-HCC Risk Adjustment models
- Comparative analysis between coding versions
- Data visualization of financial and clinical impact
- Domain expertise in Medicare Advantage and RADV compliance
Tools Used: Power BI Desktop, DAX, Excel