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Most health plans still run their risk adjustment programs backward. They wait until the year ends, then spend the next 12 months combing through old charts, chasing providers for clarification on visits they barely remember, and hoping their coders catch what they missed the first time around.
There’s a better way. Concurrent coding moves the review process upstream, catching documentation gaps and coding errors while the encounter is still fresh. It’s not a minor workflow tweak. It’s a fundamental shift in how you protect revenue and manage compliance risk.
The Real Cost of Waiting
When you review a chart six months after the encounter, you’re stuck with whatever the provider documented. If the note doesn’t support the HCC, your options are limited. You can query the provider (who won’t remember the details), accept the lost revenue, or take an audit risk by coding without adequate support.
None of these options are good. And they all stem from the same root cause: you waited too long.
Concurrent review catches problems when they’re still fixable. A provider who documented “CHF” without any supporting MEAT criteria can add clarification while the patient visit is still in their mind. That query conversation takes two minutes instead of two weeks. And the documentation gets fixed before the claim goes out the door.
How Concurrent Coding Works
The basic workflow is straightforward. You intercept encounters shortly after they occur, typically within days. Your coding team reviews the draft claim against the clinical documentation and categorizes each diagnosis code into one of four buckets.
Matches are codes that are properly documented and appropriately coded. These need no action. Adds are conditions documented in the clinical note that should be coded but weren’t captured. These represent revenue you’re entitled to but would have missed. Deletes are codes submitted without adequate documentation support. These create audit exposure. And queries are situations where the documentation is unclear and needs provider input.
The magic happens with adds and queries. In a retrospective model, you discover these months later when it’s too late to fix them. In a concurrent model, you catch them in time to act.
The Provider Education Bonus
Here’s something that gets overlooked: concurrent coding creates a continuous feedback loop with your providers. Instead of sending out educational memos about documentation problems from last year, you’re having real-time conversations using current patient cases.
“Dr. Martinez, your note from Tuesday mentioned the patient’s COPD is worsening, but you didn’t document the current spirometry results or medication adjustment. Can we add that detail?”
That conversation is specific, timely, and actionable. The provider learns what good documentation looks like because they’re getting immediate feedback on their actual work. Over time, documentation quality improves at the source, which reduces your coding burden downstream.
The Financial Impact
Organizations running concurrent review typically see chart review time drop by 40-60% because coders aren’t chasing old records and struggling to reconstruct clinical context from incomplete notes. They’re reviewing recent encounters with clear documentation while everything is still accessible.
More important than the efficiency gain is the revenue capture. When you identify an undercoded encounter during the current year, you can submit a corrected claim for this payment year. That’s money in hand now, not a recapture project for next year that may or may not succeed.
And on the compliance side, every claim you submit is already validated. You’re not building a portfolio of potential audit findings that you’ll discover later during RADV prep. You’re building a defensible book of business from day one.
Making the Transition
Moving to concurrent coding requires infrastructure changes. You need data feeds from your EHR or claims system that give you access to encounters quickly. You need workflows that prioritize speed without sacrificing accuracy. And you need provider relationships that support real-time feedback.
Start with a pilot. Pick a provider group or patient population where you have good data access and cooperative physicians. Run concurrent review alongside your existing retrospective process. Measure the difference: how many additional HCCs did you capture, how much faster were your reviews, how did providers respond to the feedback?
The results typically speak for themselves. Organizations that try concurrent coding rarely go back to the old way. Because once you experience fixing problems in real time instead of discovering them too late, retrospective-only review feels like driving while looking in the rearview mirror.
The best time to catch a documentation gap is before it becomes a missed code. The best time to educate a provider is while they still remember the patient. Concurrent coding makes both possible.
