Pre-Visit Planning and Condition Reconciliation
Effective risk capture begins before the patient arrives. Pre-visit planning enables providers to:
- Review historical conditions: Understand chronic conditions requiring annual recapture
- Identify care gaps: See suspected conditions and preventive care needs
- Prepare documentation: Have relevant clinical history readily available
- Prioritize encounter focus: Plan for high-value clinical conversations
In-Visit Documentation and Coding Checkpoints
During the clinical encounter, documentation completeness drives risk accuracy:
Condition Assessment
Document status and treatment plan for each active chronic condition.
Code Specificity
Use most specific diagnosis codes supported by clinical findings.
MEAT Criteria
Include Monitor, Evaluate, Assess, or Treat documentation for each condition.
Post-Visit Review and Validation
After the encounter, validation ensures documentation completeness:
- Coding review: Verify diagnosis codes match documentation
- Gap analysis: Identify conditions discussed but not coded
- Query resolution: Address documentation deficiencies through provider queries
- Compliance check: Ensure codes meet guideline requirements
Three downloads risk adjustment teams actually use
Checklists, playbooks, and frameworks — built for analysts, auditors, and VPs working RAF, RADV, and HCC.
2026 RADV Audit Readiness Checklist
12-point compliance checklist for documentation, diagnosis code validation, extrapolation defense, and pre-audit scrub workflows.
RAF Score Optimization Playbook
Tactical guide for analysts: HCC recapture workflows, V28 transition impacts, prospective gap-closure plays, and KPIs that move RAF lift.
Risk Adjustment Analytics Playbook
How payer leaders sequence prospective and retrospective risk adjustment for compounding RAF lift. Deployment patterns, KPIs, and a VP-level operating rhythm.
Team-Based Workflows and Accountability
Risk adjustment success requires coordinated effort across clinical teams:
Provider Role
Clinical assessment, documentation, and code selection.
Care Team Role
Pre-visit preparation and care gap outreach.
Coding Team Role
Validation, query management, and compliance review.
Leadership Role
Performance monitoring and process improvement.
Analytics That Support Provider Workflows
Population Health Risk Stratification
Stratify patients by risk level to prioritize care management efforts.
RAO
Risk Assessment & Optimization analytics for provider organizations.
CDI
Clinical Documentation Improvement platform for documentation excellence.
ICD-10 Coding Guidelines
Resources for coding accuracy and guideline compliance.
RAF Score Calculation
Understanding RAF score calculation for provider performance insights.