Most health plans wait until the year is over to review their coding. By then, you’re playing catch-up on 12 months of documentation gaps, missed HCCs, and compliance issues you can’t fix. That’s not risk management. That’s hoping for the best.
Concurrent coding flips this approach. Instead of reviewing charts after the fact, you’re validating diagnosis codes and documentation while the patient encounter is still fresh. Think of it as bringing retrospective review upstream, where you can actually do something about the problems you find.
Here’s why this matters now more than ever.
The Problem With Waiting
When you review last year’s charts this year, you’re stuck with what you’ve got. The provider wrote what they wrote. The documentation is final. You can identify the gaps, count the revenue you left on the table, and maybe send out an educational memo. But you can’t change the outcome.
The average health plan misses between 10% and 25% of legitimate HCC revenue because of incomplete documentation or coding errors that could have been caught in real time. That’s money you earned but can’t claim. And when audit season comes around, those same documentation gaps become liabilities instead of just missed opportunities.
What Concurrent Coding Actually Does
Concurrent coding reviews encounters shortly after they occur, typically within days or weeks. You’re validating three things:
First, are the documented conditions supported by the clinical evidence in the note? If a provider lists diabetes with complications but the note only mentions blood sugar monitoring, you’ve got a defensibility problem.
Second, are there conditions present in the clinical documentation that weren’t coded? A detailed note about chronic kidney disease that somehow didn’t make it onto the claim represents lost revenue.
Third, are there overclaimed conditions that could trigger audit findings? A diagnosis code for an acute condition that resolved months ago shouldn’t still be on the active problem list.
The Workflow That Makes It Work
Effective concurrent coding requires a systematic approach. Start with EHR integration or claims feeds that give you access to encounter data while it’s still actionable. You need to see the draft claim before it goes out the door.
Next, your coding team reviews the documentation against the submitted diagnosis codes. They’re looking for matches, adds, and deletes. A match means the code is properly supported. An add means there’s a condition in the note that should be coded but wasn’t. A delete means there’s a code without adequate support.
Here’s the critical part: when you find gaps or issues, you can loop back to the provider right away. “Dr. Johnson, your note from last Tuesday mentioned stage 3 CKD, but it didn’t make it onto the claim. Can we get that added?” That conversation is easy when the encounter is recent. It’s nearly impossible six months later.
The Education Opportunity
Concurrent review creates a continuous feedback loop with your providers. Instead of telling them in March 2026 about documentation problems from January 2025, you’re having real-time conversations using actual patient cases they just saw.
This targeted education is more effective than general training sessions. When you can point to a specific patient and say, “Your note needs to include the severity and laterality for this condition,” providers understand immediately. They’re still thinking about that patient. The clinical context is fresh.
Over time, this improves documentation quality at the source. Providers learn what good documentation looks like because they get consistent, timely feedback on their own work.
The Financial Impact
Organizations that implement concurrent coding typically see a 15-30% reduction in chart review time because they’re catching issues before they compound. Coders spend less time investigating old charts and more time on current encounters where they can make a difference.
More importantly, you’re capturing revenue in the current year instead of hoping to recapture it retrospectively. When you identify an undercoded encounter in week one, you can correct it before the claim goes out. That’s revenue you get this year, not revenue you might reclaim next year if you catch it during retrospective review.
The Compliance Angle
Concurrent coding also reduces your audit exposure. Every claim you submit should be defensible on day one. When you’re validating documentation and coding accuracy before submission, you’re building a defensible portfolio from the start.
This is especially important as regulatory scrutiny increases. CMS audits are focusing more on documentation quality and evidence-based coding. Having a process that validates every encounter before it becomes a claim puts you in a much stronger position.
Making The Shift
Moving from retrospective to concurrent review doesn’t happen overnight. You need the right technology infrastructure to intercept claims before submission. You need workflow changes so coders can review encounters quickly. And you need provider buy-in so they’re responsive when you identify issues.
Start small. Pick a high-risk patient population or a set of providers who are open to feedback. Prove the concept works. Measure the results: how much revenue did you recover, how many audit risks did you prevent, how much time did you save? Then expand.
The organizations succeeding with concurrent coding treat it as a continuous improvement process, not a one-time project. They’re constantly refining their workflows, training their teams, and improving their technology. Because in value-based care, waiting until next year to fix this year’s problems isn’t a strategy. It’s just expensive.
