The Concurrent Coding Workflow That Doubles Your Capture Rate (Without Doubling Your Staff)

Your organization does retrospective risk adjustment. You review charts months after encounters happen. Your capture rates are decent. But you keep hearing that concurrent coding (reviewing charts within days of encounters) dramatically improves results.

The problem is you can’t afford to double your coding staff. Concurrent coding sounds expensive and resource-intensive.

Here’s how to implement concurrent coding workflows that dramatically improve capture rates without proportionally increasing costs.

The Triage System

The biggest mistake organizations make with concurrent coding is trying to review everything concurrently. That’s impossibly expensive.

Smart concurrent programs use ruthless triage. Only high-value encounters get concurrent review. Everything else goes to standard retrospective workflows.

What’s high-value? Hospital discharges. New chronic diagnosis visits. Complex patients with multiple HCC opportunities. Providers with known documentation problems.

A wellness visit for a healthy 50-year-old doesn’t need concurrent review. It can wait for retrospective. A hospital discharge for an 80-year-old with CHF, CKD, and diabetes needs immediate concurrent review while documentation is fresh and correctable.

Most organizations find that 15-20% of encounters account for 60-70% of incremental HCC value. Concurrent review those 15-20%. Handle the rest retrospectively.

This dramatically reduces the resource requirement. You’re not reviewing everything concurrently. You’re surgically targeting high-value opportunities.

The Automated Intake

For concurrent coding to work, encounters need to flow into your review queue immediately, not days later when someone manually pulls charts.

Automated intake means integrating with your EHR or claims feed to detect encounters as they occur. A patient is discharged from the hospital. Within hours, that chart is automatically queued for concurrent review.

Without automation, concurrent coding doesn’t work. By the time someone manually identifies charts for review and retrieves them, you’ve lost the concurrent advantage.

The technical requirements aren’t trivial. You need real-time or near-real-time data feeds from encounter systems. But this automation is what makes concurrent coding operationally feasible.

The Coder Skill Difference

Concurrent coding requires different skills than retrospective coding. Concurrent coders need to think fast and communicate well.

In retrospective coding, coders have complete documentation and can take their time. In concurrent coding, documentation is often incomplete. The provider hasn’t finished their note. Lab results are pending. The coder needs to code what’s available and flag what’s missing.

Concurrent coders also interact with providers frequently. They’re sending real-time queries while providers still remember the patient. This requires communication skills that retrospective coders don’t necessarily need.

Not every good retrospective coder makes a good concurrent coder. The skill sets differ. When building concurrent teams, select for speed, comfort with ambiguity, and communication ability.

The Fast Query Workflow

The whole point of concurrent coding is that documentation is fresh and correctable. But that only works if your query turnaround is fast.

Sending a query three days after the encounter defeats the purpose. By then, the provider has seen 60 other patients. The memory advantage is gone.

Concurrent query workflow needs to be: encounter happens, coder reviews within 24 hours, query sent immediately if needed, provider responds within 24-48 hours, documentation updated, final coding happens.

This requires building query templates that are fast to customize, making queries easy for providers to respond to, and creating escalation paths for time-sensitive documentation gaps.

If your query process takes 5-7 days, you’re not doing concurrent coding. You’re doing slightly-less-delayed retrospective coding.

The Partial Completion Strategy

In retrospective coding, you don’t submit until coding is 100% complete. In concurrent coding, you can’t always wait for perfection.

Smart concurrent programs code what’s clear and flag what’s uncertain. If a hospital discharge has obvious CHF and CKD but potential diabetes complications that aren’t yet documented, code the CHF and CKD now. Flag the diabetes question for follow-up.

This “partial completion” approach lets you capture value incrementally rather than waiting for perfect documentation that might never arrive.

Some HCCs are clearly supported by current documentation. Capture those immediately. Some HCCs need additional information. Query for that information but don’t delay capturing what’s already clear.

The Provider Relationship Requirement

Concurrent coding only works with strong provider relationships. You’re asking providers to respond to queries within 24-48 hours. That requires buy-in.

Providers need to understand why concurrent coding matters. It’s not just about revenue. It’s about accuracy. Concurrent coding improves clinical documentation quality, which improves care coordination and patient safety.

Frame concurrent coding as a quality improvement initiative, not a revenue initiative. Providers respond better when they see clinical value, not just financial value.

Organizations that succeed with concurrent coding invest heavily in provider education and relationship management. They assign dedicated liaisons to high-volume providers. They provide regular feedback on documentation quality. They celebrate improvements.

The Technology Requirements

Concurrent coding has higher technology demands than retrospective coding.

You need real-time data feeds to identify encounters immediately. You need fast chart retrieval to get documentation within hours, not days. You need integrated communication tools so coders can query providers without leaving the platform. You need workflow automation to handle the high velocity of encounters.

Retrospective coding can work with basic technology. Concurrent coding requires sophisticated platforms.

Before implementing concurrent coding, audit your technology stack. Can you get real-time encounter notifications? Can you retrieve charts fast? Can you support high-velocity workflows? If the answer is no, you need technology upgrades before concurrent coding is feasible.

The ROI Reality

Concurrent coding isn’t free. It requires incremental resources, technology investment, and process changes.

But the ROI is real. Organizations implementing concurrent coding typically see 25-40% improvement in capture rates for the encounters they review concurrently. That’s not 25-40% across all encounters (because you’re being selective). But for the high-value encounters getting concurrent review, the lift is substantial.

The key is targeting the right encounters. If you implement concurrent coding for low-value encounters, you’ll spend money without adequate return. If you target high-value encounters where documentation is likely to be incomplete and correctable, the ROI is strong.

What Actually Works

Concurrent coding isn’t all-or-nothing. You don’t need to review everything concurrently to get value.

Start small. Pilot concurrent coding for hospital discharges only. That’s 5-10% of encounters but contains massive HCC value. Get that working. Then expand to other high-value encounter types.

Use ruthless triage to focus concurrent resources on encounters where documentation gaps are most likely and most valuable. Automate intake so encounters flow to review immediately. Build fast query workflows. Accept partial completion. Invest in provider relationships. Ensure your technology can support high-velocity workflows.

Done right, concurrent coding can double your capture rate on targeted encounters without doubling your staff. Done wrong, it’s just expensive retrospective coding with tighter deadlines.