Frequently Asked Questions
When did the 28 go into effect?The CMS-HCC model Version 28 (V28) for Medicare Advantage risk adjustment is being phased in and will be fully in effect by January 1, 2026, completely replacing V24. This transition shifts to a more updated diagnostic model, reducing the number of ICD-10-CM codes and increasing HCC categories to 115, impacting payment accuracy.
What are the new codes for 2026?The 2025/2026 healthcare coding landscape, as of early 2026, is dominated by new CPT and HCPCS codes focusing on Artificial Intelligence (AI) diagnostics, remote monitoring, and enhanced evaluation/management (E/M) reporting, including 309 new Tebra HCPCS Level II codes. Key updates feature seven Category III AI codes for imaging/ECG, alongside new behavioral health, wound care, and atherosclerotic cardiovascular disease (ASCVD) services.
What are risks adjustable?Adjustable risks generally refer to financial products with fluctuating, non-fixed terms, primarily Adjustable-Rate Mortgages (ARMs) and Adjustable Life Insurance. The primary risks involve interest rates or payment obligations increasing based on market conditions, potentially leading to unaffordable payments, default, or loss of equity.
Some plans are going virtual vs in-person, how does this affect me?Virtual-first health plans and increased telehealth integration often reduce your healthcare costs by providing lower premiums, lower out-of-pocket expenses, and no travel costs, with virtual visits frequently being the most affordable option. While many states and insurers now mandate "payment parity," meaning virtual visits are billed similarly to in-person care, you may still experience lower overall expenses due to increased convenience.
What is the difference between value based care and Fee-For-Services?Value-Based Care (VBC) is a healthcare delivery model that rewards physicians with incentives for improving patient health outcomes, reducing hospitalizations, and providing efficient, high-quality care. It shifts the focus from the quantity of services (fee-for-service) to the quality of care.
Some plans are going virtual vs in-person, how does this affect me?Virtual-first health plans and increased telehealth integration often reduce your healthcare costs by providing lower premiums, lower out-of-pocket expenses, and no travel costs, with virtual visits frequently being the most affordable option. While many states and insurers now mandate "payment parity," meaning virtual visits are billed similarly to in-person care, you may still experience lower overall expenses due to increased convenience.
Did you know that you can bill two units for the flu test?Billing two units of CPT code 87804 (rapid influenza test) is appropriate when separate, distinct results for both Influenza A and Influenza B are reported from a single patient encounter.