Understanding CMS’s AI Strategy: What It Means for Your Risk Adjustment Program

CMS is using AI. If you’re not, you’re playing defense without a helmet.

CMS announced it will deploy AI-powered coding review tools to support RADV auditors. This isn’t a future possibility. It’s happening now.

The January 2026 RADV memo confirmed what many suspected: CMS is scaling its audit capacity with artificial intelligence to spot unsupported diagnoses, scan for statistical outliers, and challenge payment integrity faster than ever before.

For Medicare Advantage plans still relying on spreadsheets and manual chart review, the gap between your capabilities and CMS’s capabilities is about to become a liability.

This webinar breaks down what CMS’s AI strategy means for your risk adjustment program and what you need to do about it.

You’ll walk away with:

How CMS is using AI to accelerate RADV audits and what specific capabilities they’re deploying
Why manual processes can’t keep pace with AI-powered enforcement and the risks of falling behind
The difference between “automation” and “augmentation” in clinical AI, and why it matters for compliance
How to evaluate your current technology stack against CMS’s capabilities
What an AI-matched audit defense strategy looks like in practice

Panelists

Wynda was a RADV auditor when the program first started and maintains close contact with current CMS auditors. She brings a unique perspective on how CMS reviews documentation and what AI-powered tools will change about the audit process.

Raxit is a healthcare AI researcher with over 15 years of experience in clinical NLP, knowledge graphs, and machine learning. A published author with 70+ academic citations, he focuses on building explainable AI systems that deliver audit-defensible coding accuracy. At RAAPID, Raxit leads the development of Neuro-Symbolic AI solutions that enhance risk adjustment precision and regulatory compliance.

Cat Valyi is a seasoned B2B healthcare marketing strategist with over 30 years of experience and the creator of the 3D Strategic Marketing Approach. She’s also a speaker, podcast host, and founder of CV Strategic Marketing Solutions—helping healthcare organizations grow through clear, results-driven marketing.

“CMS is using AI. You need to make sure you’re matching that capability. If you’re not using a similar tool on your side, you’re essentially playing defense without a helmet.“