In today’s healthcare landscape, one thing is crystal clear: documentation is currency. And nowhere is that truer than in the world of risk adjustment — where the accuracy of your documentation can directly impact millions in reimbursement, resource allocation, and patient care outcomes.
But here is the kicker: Even the best risk adjustment models fall flat without solid Clinical Documentation Integrity (CDI) behind them.
The Problem: You are Coding What’s Documented… But Are You Documenting What’s Clinically Present?
If your providers are not capturing the full picture of a patient’s health status — including the severity and specificity of chronic conditions — then your risk scores (RAF scores) are almost certainly underreported. That is money and care support left on the table.
Too often we see:
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- CHF coded as “unspecified”.
- Diabetes complications are missing.
- CKD inferred from labs but never documented.
- Morbid obesity overlooked despite a BMI of 45.
- Schizophrenia reduced to vague notes like “history of psychosis”.CDI + Risk Adjustment = Real Results
When CDI teams and risk adjustment leaders work in sync, the results speak for themselves. Providers can achieve improved RAF scores through accurate HCC capture, audit-ready documentation that meets MEAT criteria, more appropriate resource allocation for complex patients, cleaner data for population health and analytics, and increased provider awareness and engagement.
This is where transformation happens — not just in compliance, but in revenue integrity, patient care, and organizational performance.
Want to Make This Real in Your Organization?
We have created a high-impact webinar that dives deep into how CDI and Risk Adjustment should work hand-in-hand. This is more than theory — it is packed with real-world strategies, compliant query templates, missed HCC lists, and clinical indicators that CDI teams can use immediately.
Looking for a deeper dive into this subject?
Theresa Rosa, RHIA, CCS
Senior Coding Quality Auditor
Theresa brings more than 15 years of experience in health information management and coding to her role at Haugen Consulting Group. Her career spans leadership roles, where she developed a reputation for excellence in compliant coding and documentation practices, revenue cycle optimization, and coder education.
As a Certified Coding Specialist (CCS) and Registered Health Information Administrator (RHIA), Theresa has overseen inpatient and outpatient coding operations, conducted high-level audits, and led staff development initiatives across multiple medical centers. She has provided policy guidance and coding oversight nationally, co-chairing the VHA National Coding Council and being a subject matter expert for the VHA HIM Program Office.
Theresa is passionate about continuous learning and education. She has presented national HIM education, developed coding SOPs and training tools, and conducted coder and provider education that significantly improved coding accuracy and clinical documentation practices across multi-specialty departments. Currently pursuing her Master’s in Health Informatics, she remains committed to advancing the profession through education and mentorship.
Excellent article! Touches on the real monetary impacts that clear documentation can provide. CDI plays a vital role in RAF. Coders are not clinical validation and, unless queries are done on major diagnoses, CDI can help mitigate revenue losses through concurrent reviews and provider education.