Protect Your MSSP Benchmark: The 90-Day Secret to Accurate Risk Capture

Your MSSP benchmark hinges on one critical rule: chronic conditions must be flagged, documented, and closed every 90 days. Missed diagnoses = an underweighted benchmark, leaving your ACO financially exposed.

Here’s the fix:

1. Flag suspected conditions quarterly (meds, labs, care gaps).

2. Document HCCs during visits—specificity is key.

3. Close the loop: confirm, rule out, or refer.

Skip the cycle? Risk scores regress, costs spike, and audits loom. Compliance isn’t year-end—it’s every 90 days.

Start today:

• Build a suspect condition registry.

• Train providers on HCC validation.

• Audit charts monthly, not annually.

CMS’s seismic shift to HCC V28 is here—and if your ACO isn’t prepared, your RAF scores could plummet, slashing your Medicare Shared Savings Program (MSSP) benchmarks regardless of patient outcomes.

The Urgency:

• 67% of 2025 RAF scores now hinge on V28’s stricter rules—more HCCs, reweighted conditions, and brutal specificity demands.

• Chronic conditions like CKD Stage 3 no longer count unless paired with complications. "Diabetes" alone won’t cut it—documentation must detail complications (e.g., "diabetes with neuropathy").

• Benchmarks = Revenue. Miss the mark, and shared savings vanish—or worse, your ACO triggers shared losses.

Your Survival Kit:

1. Audit Top Codes – Does your #1 diagnosis still map to an HCC?

2. Train Clinicians – V28 demands precision. "Good enough" notes = financial risk.

3. Leverage Annual Wellness Visits – Embed HCC recapture into every AWV.

4. Adopt MEAT Criteria – Every diagnosis must show ongoing Monitor, Evaluate, Assess, Treat.

5. Track Quarterly – Don’t wait for December—run RAF reports now.

 By 2026, V28 is 100% in effect. Delay = years of disadvantage.

Protecting your benchmark isn’t optional—it’s survival.

The 2025 Medicare Shared Savings Program (MSSP) update presents a pivotal moment for Accountable Care Organizations (ACOs). With CMS emphasizing performance accountability and health equity, ACOs must decide: Does our organization have the agility, financial resilience, and technology to thrive under Pathways to Success—and which track (Basic or Enhanced) aligns with our vision?