---
type: source
title: "CMS 2027 Medicare Advantage and Part D Advance Notice: Chart Review Exclusion and Star Ratings Reform"
author: "CMS / Multiple analysis sources"
url: https://www.cms.gov/newsroom/fact-sheets/2027-medicare-advantage-part-d-advance-notice
date: 2026-02-01
domain: health
secondary_domains: []
format: report
status: unprocessed
priority: high
tags: [cms, medicare-advantage, 2027-rates, chart-review-exclusion, star-ratings, V28, risk-adjustment]
---

## Content

### Chart Review Exclusion (2027)

- CMS proposes excluding ALL diagnoses from unlinked chart review records (not tied to documented service)
- Diagnoses from chart reviews allowed only if tied to actual medical encounter
- Projected savings: **>$7 billion in 2027**
- This is the most targeted reform to date against retrospective code-mining

### V28 Phase-In Completion

- 2026 is the FINAL year of V28 phase-in
- 2027 model continues V28 clinical classification but recalibrated with newer data (2023 diagnoses, 2024 expenditures — updated from 2018/2019)
- Notable: CKD Stage 3B and 3 now have separate coefficients (previously constrained to same value)

### Star Ratings Reforms

- New depression screening and follow-up measure (2027 measurement year, 2029 ratings)
- CMS exploring modernization: AI-based risk adjustment, alternative data sources
- Exploring timeline compression to reduce current 2-year lag between measurement and payment

### Industry Impact

- Insurers warn flat 2027 rates + chart review exclusion could drive benefit cuts and market exits
- Combined with V28 completion, this is the most structurally significant reform year since MMA 2003
- Purpose-built MA plans (lower coding intensity, genuine care delivery) are better positioned than acquisition-based plans

### Forward-Looking Signals

- CMS exploring next-generation AI-powered risk adjustment model
- Potential for quality measurement timeline modernization
- Signals continued regulatory tightening trajectory

## Agent Notes
**Why this matters:** 2027 is shaping up as a structural inflection for MA. Chart review exclusion + V28 completion + flat rates = the first sustained compression of MA economics since the BBA 1997 crash. The key question: does this trigger another 1997-style plan exit cycle, or have purpose-built plans evolved enough to survive where acquisition-based models fail?
**What surprised me:** CMS is exploring AI-powered risk adjustment. If implemented, this would fundamentally change the coding game — AI could detect upcoding patterns across millions of records in ways that audit sampling can't.
**KB connections:** [[CMS 2027 chart review exclusion targets vertical integration profit arbitrage by removing upcoded diagnoses from MA risk scoring]], [[Devoted is the fastest-growing MA plan at 121 percent growth because purpose-built technology outperforms acquisition-based vertical integration during CMS tightening]]
**Extraction hints:** Claim about 2027 as structural inflection year for MA economics — convergence of V28, chart review exclusion, and flat rates creating the first sustained compression since BBA 1997.

## Curator Notes
PRIMARY CONNECTION: [[CMS 2027 chart review exclusion targets vertical integration profit arbitrage by removing upcoded diagnoses from MA risk scoring]]
WHY ARCHIVED: Updates and deepens the existing KB claim with the full 2027 reform package context.
EXTRACTION HINT: The parallel to BBA 1997 is the key analytical frame — will 2027 trigger plan exits or differentiation?
