The RCxRules Blog

Why ACOs Are Evolving from a Retrospective Coding Review to a Concurrent Coding Review

Moving from a retrospective coding review process to a concurrent coding review process has many advantages. Learn why some of the most progressive ACOs in the country use concurrent coder review—and how to begin your own transition.

Increased Efficiency

The below graphics clearly illustrate the differences in complexity and efficiency between a retrospective and a concurrent review process:

Retrospective Review Process


In this retrospective process, the rebilling (second pass) process is time consuming and cumbersome for billing staff, as every payer has their own corrected claim requirements and file policies. Once re-submitted, follow up is needed to ensure the claim has been accepted and any added or removed HCC codes are incorporated into the group’s RAF score calculation.

Concurrent Review Process


The concurrent process is simpler and more efficient, with no need for a second pass.

Real-Time Provider Insights

A concurrent process allows for feedback from a coder within a day or two of the patient visit. This is a crucial part of an effective workflow to improve provider HCC capture. Depending on the medical group’s policy, real-time feedback alerts providers to clinical documentation improvements, which could lead to amending the clinical note and codes to reflect the patients’ conditions more accurately. Retrospective data is often months old, which makes provider education and insight challenging, irrelevant, and confusing.

How to Evolve

Concurrent review for risk adjustment is a relatively new concept for most groups. In the past, the focus has typically been on providers owning HCC capture, with a retrospective review in place to catch errors. Introducing this concurrent HCC coding review concept to your team may be the first step in evolving to a more efficient process.

RCxRules HCC Coding Software can help with an easy transition and successful execution of a concurrent review process. To avoid overwhelming your HCC coders with the need to review all encounters at once, the software uses filtering logic to help prioritize and target the highest value encounters. Most groups we work with have small coding teams (just one or two coders), so prioritizing their efforts for maximum impact is vital. The software can make a single coder as productive as three or four coders.

We’ve seen this evolution work in the real-world many times. Don’t just take our word for it—hear directly from one of our customers who has successfully incorporated a concurrent review process. Watch this on-demand webinar to learn how Crystal Run Healthcare, a 400+ provider, multi-specialty group successfully evolved their HCC Coding workflow and hear about the positive impact it’s had on their RAF scores and bottom line.



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