The chronic conditions your engine should flag before the reset closes
Every documented chronic HCC drops off at midnight on December 31. If it is not re-documented and re-coded during the calendar year, its risk weight resets to zero and the revenue walks out the door with it.
The reset is a hard date, not a rolling average
CMS-HCC risk scores are rebuilt from a single collection year of diagnoses. A patient coded with a chronic condition last year starts this year at zero for that condition. The engine's whole job is to surface which conditions have not yet been re-documented while there is still a visit left to do it in.
Toggle the open gaps. Watch the panel value move.
Select the chronic conditions documented in a prior year but not yet recaptured this year. The panel sums the incremental risk and estimates the revenue at stake. Weights shown are illustrative of the V28 structure for a community, non-dual member and are not a payment quote.
Unrecaptured chronic HCCs
Illustrative model. Actual dollars depend on your county rate book, the member's full risk profile, coding intensity adjustment, and the V28 normalization factor in the CY2026 Rate Announcement. Use it to prioritize, not to bill.
A flag is only useful if it names the documentation
Recapture fails at the note, not the model. A code without support does not survive a RADV review. These are the four things every recaptured HCC needs in the encounter, plus the specificity traps that quietly drop a condition out of a payable category under V28.
Monitor
Signs, symptoms, disease progression or regression noted at this visit.
- Diabetes: current glucose control, A1c trend
- CHF: weight, edema, functional class
Evaluate
Test results, response to treatment, exam findings tied to the condition.
- CKD: eGFR reviewed and staged
- COPD: spirometry or O2 status referenced
Assess
The condition addressed in the assessment, not carried silently in history.
- Stated in the A/P, not just the problem list
- Status clarified: stable, worsening, controlled
Treat
Medication, referral, order or plan that ties the diagnosis to the visit.
- Rx continued or adjusted with reason
- Specialist referral or care plan update
How V28 (our HCC engine) decides what to surface
Recapture is a five-step comparison the engine runs every time it sees a panel. The output is not a score. It is a worklist: which member, which condition, which visit, and what the note is missing.
Read prior year
Pull every chronic HCC captured in the last collection year.
Check this year
Has a qualifying encounter re-documented it since Jan 1?
Test the note
Does the encounter carry M.E.A.T. and an FY2026-specific code?
Score the gap
Weight the open condition and rank by revenue and closeability.
Route it
Send to the visit, the coder, or the provider query before Dec 31.
The 2026 guidance this page is built on
No invented benchmarks. Every claim above traces to a named, current source. Verify against the primary documents before you operationalize anything.
Turn the reset deadline into a ranked worklist, not a year-end scramble
ASP-RCM Solutions runs risk-adjustment gap closure inside your workflow: a V28-aware engine that surfaces unrecaptured chronic HCCs, names the documentation each one needs, and routes the highest-value, most-closeable gaps to the right visit while the window is still open. Grounded in the FY2026 code set, tuned for RADV defensibility, and built to hand your coders a list instead of a mystery.
Book a recapture readiness reviewRelated reading
The new steady state, in four numbers
CMS now audits roughly 550 MA contracts every year on a quarterly RADV calendar, with PY 2020 audits starting
Read →Field noteSurviving RADV Extrapolation: MEAT Documentation That Holds
A RADV audit HCC documentation MEAT playbook: why a diagnosis without Monitor, Evaluate, Assess or Treat evide
Read →InsightWhat OIG is actually reviewing
OIG Work Plan item SRS-E-26-004 puts Medicare Advantage prior authorization for post-acute care under review.
Read →