By Jerry smith 
Selecting the right partner for Risk Adjustment Coding is one of the most consequential decisions health plans face. The choice can determine not only how effectively risk is captured but also how well a plan withstands audits, stabilizes revenue, and supports providers in documentation practices. A true partner should be more than a vendor—they should function as an extension of your team, offering expertise, innovation, and trust.
Does the Partner Balance Human Expertise with Technology?
Coding accuracy requires the nuance of experienced coders, but volume and complexity demand automation. The right partner combines skilled reviewers with advanced tools like natural language processing and chart prioritization to surface gaps efficiently. Asking how they blend human judgment with technology can reveal whether they prioritize speed at the expense of accuracy or truly strike the right balance.
How Strong Is Their Audit Readiness Program?
CMS scrutiny continues to intensify, making defensible documentation essential. Health plans should ask about the partner’s approach to compliance, from query processes to internal audits. Do they simulate RADV audits? Can they provide transparent audit trails? A partner that prepares for scrutiny every day builds confidence that revenue and reputation will be protected.
Can They Scale Without Losing Quality?
Health plans often face fluctuating patient volumes or expansion across networks. A coding partner must demonstrate the ability to scale services without compromising accuracy or turnaround times. This involves both staffing models and system capabilities that can flex to meet changing demands.
Do They Support Provider Engagement?
The best coding partners don’t just work in the background—they help providers understand the importance of complete documentation. Health plans should ask how the partner trains clinicians, delivers feedback, and encourages consistent documentation habits. Strong engagement programs reduce rework and create more accurate risk profiles at the point of care.
What Insights Do They Deliver Beyond Coding?
A valuable partner provides more than coded charts. Look for vendors that offer data-driven insights on risk trends, RAF score projections, and population health opportunities. These insights allow health plans to move from reactive adjustments to proactive planning, creating a stronger long-term strategy.
Conclusion
Asking the right questions when choosing a partner ensures that health plans align with organizations capable of driving compliance, efficiency, and strategic growth. A partner who brings transparency, scalability, provider engagement, and actionable insights can make the difference between surviving audits and thriving in a value-based model. For health plans committed to accuracy and stability, the first step is choosing a collaborator who elevates Risk Adjustment Coding into a true strategic advantage.