THE CHALLENGE
Risk adjustment depends on complete, current diagnosis capture. In practice, conditions that exist in the medical record—or are strongly suggested by utilization—often never reach a claim. Suspect lists without clinical confirmation create weak documentation and audit risk. And most provider and plan teams lack capacity to outreach, schedule, and complete focused coding visits at scale.
Undercoding is Common
Historical and chronic conditions drop off when they are not re-documented in the payment year—leaving RAF and care planning incomplete.
Lists are not Enough
Recapture and suspect reports without bedside (or virtual) confirmation rarely produce MEAT-ready support for every code.
Capacity is the Bottleneck
PCPs and internal coding teams cannot chase every gap. A dedicated clinical partner closes the execution gap.