A Wake-Up Call for Health Plans and Providers
Concurrent Coding lets you review every encounter while the ink is still drying on the note. Instead of waiting months for a retro pass—or losing sleep before the next payment deadline—teams surface missed conditions, documentation gaps, and RAF impact within hours. The change feels small on paper; in practice, it closes revenue leaks that quietly add up to seven figures each year.
Post-Visit Lag: The Silent Profit Erosion
Traditional coding cycles chase charts long after claims leave the building. By the time a variance pops up, the patient is gone, the physician’s memory has faded, and re-work pulls coders from higher-value tasks. Delayed insight also blindsides finance leaders when CMS claw-backs arrive, undermining value-based performance bonuses.
What Sets Concurrent Coding Apart
- Real-time data ingestion from EHRs and document repositories
- AI-assisted condition detection backed by evidence links for coders
- Same-day feedback loops that let physicians clarify notes before claims drop
This cadence turns coding into a proactive safeguard rather than a detective exercise.
Three Pillars of an Effective Program
- Instant Visibility
Streaming encounter data into a centralized queue lets auditors spot under-reported conditions while the visit context is fresh. Quick clarification requests mean fewer addenda and cleaner claims. - Evidence-Driven Automation
Neuro-Symbolic models sift through structured and unstructured notes, proposing HCC codes only when clinical indicators meet MEAT standards. Human coders keep final authority, but their review time drops by half. - Workflow Harmony
Insights surface inside the EHR through ribbons or task lists, so physicians never toggle screens. Finance, compliance, and quality teams share the same dashboard, replacing email threads with a single source of truth.
The Revenue Math
A multi-state Medicare Advantage plan used concurrent review on 32,000 members. In two weeks, coders validated 992 under-reported HCCs worth nearly $3 million and flagged 1,500 over-stated codes before submission. Another provider group saw chart review minutes fall from 43 to 21, unlocking $2,320 per member while protecting physician time.
Operational Wins for Clinical Teams
- 60 % reduction in chart chase calls
- 25 % lift in review accuracy
- Fewer provider queries because evidence is attached to every suggested code
Clinicians focus on care, not paperwork, and coders shed repetitive manual searches.
Building an Audit-Ready Culture
Concurrent review leaves a transparent audit trail—who touched the chart, what was added, what was removed, and why. When external auditors arrive, records are already organized, timestamped, and justified. The same technology that drives revenue also lowers compliance anxiety.
Getting Started Without Workflow Shock
- Identify high-volume service lines where missed codes hurt most.
- Integrate a small batch of encounters through secure APIs or SFTP.
- Measure lift in RAF and coder productivity; expand in 30-day sprints.
- Use findings to guide targeted physician education rather than broad retraining.
Conclusion: Turning Compliance Pressure into Financial Strength
Health organizations that move coding upstream protect margin, lighten clinician workloads, and walk into audits with confidence. As payment models tighten, those benefits compound. Teams that adopt concurrent review today will meet tomorrow’s RADV Audits in Risk Adjustment with data-driven calm instead of costly surprises.
