A successful risk adjustment program doesn’t happen by chance—it requires a structured, strategic approach. The first 30 days are critical for establishing a strong foundation, aligning key stakeholders, and setting the stage for long-term success.

 

Laying the groundwork early helps organizations sidestep common pitfalls, streamline operations, and seamlessly transition to an optimized risk adjustment strategy. By following a clear, proactive roadmap, teams can tackle challenges head-on and set achievable goals for continuous improvement.

 

This guide breaks down the essential steps to maximize impact in the crucial first month—helping you drive accuracy, compliance, and financial performance from day one.

 

Why the First 30 Days Matter

 

A well-structured action plan in the first 30 days is critical to ensure that risk adjustment efforts are practical and sustainable. This period allows organizations to establish a clear direction, identify potential challenges, and implement solutions before inefficiencies become entrenched. 

 

Without a defined roadmap, healthcare providers may struggle with inconsistent coding practices, lack of clinician engagement, and missed opportunities for accurate documentation. Organizations can ensure better financial outcomes, compliance, and patient care by setting clear objectives and taking deliberate actions.

 

The next step is breaking down the 30-day process into manageable phases. 

 

Week-by-Week Overview

 

A week-by-week approach ensures that each critical component, from data analysis to training and evaluation, is tackled systematically, maximizing efficiency and long-term success.

 

Week 1: Data Analysis & Identifying Gaps

 

The first week focuses on understanding existing coding practices, identifying discrepancies, and pinpointing outliers. By conducting a thorough data analysis, organizations can establish benchmarks and determine the most pressing areas for improvement.

 

1. Assess Current Coding Practices

• • Conduct a data analysis to understand existing coding trends.
  • Compare diagnosis prevalence to regional or national prevalence rates in a comparable population.
  • Identify variations in coding accuracy among different clinics and providers.2. Recognize Key Outliers

• • Determine which providers or clinics have significantly different coding rates.
  • Investigate whether outliers are due to documentation gaps, lack of training, or operational limitations (e.g., missing diagnostic tools).
  • Address immediate discrepancies to ensure standardization.

2. Review HCC Code Prioritization

• • Identify high-impact conditions that are underreported.
  • Develop a priority list of prevalent conditions that can be easily diagnosed, documented and treated.

 

Quick Tip: For a deeper understanding of the official guidelines and risk adjustment methodology, organizations can refer to the Centers for Medicare & Medicaid Services (CMS), which provides an authoritative resource on HCC coding and the CMS risk adjustment model. This can guide your efforts in aligning coding practices with national standards and ensuring accuracy in reporting.

Week 2: Establishing Education & Training Plans

 

The second week is dedicated to developing a structured training program tailored to different roles. This includes defining training objectives, choosing effective teaching formats, and ensuring leadership buy-in to drive engagement and adherence to coding best practices. 

 

3. Define Training Needs

• • Identify knowledge gaps in clinical and coding teams.
  • Develop educational content tailored to different roles (e.g., clinicians vs. coders).
  • Establish training goals that align with compliance and accuracy improvement.

4. Choose an Effective Training Format

• • Decide between one-on-one coaching, workshops, or digital learning platforms.
  • Consider a hybrid approach if resources allow.
  • Ensure the format aligns with organizational culture and clinician workflow.

5. Gain Leadership Buy-in

• • Engage medical directors and clinical leadership in decision-making.
  • Address potential resistance by explaining the benefits of improved coding accuracy.
  • Standardize controversial HCC coding decisions to avoid inconsistencies across providers.

Quick Tip: Training is most effective when teams access interactive, on-demand learning tools. Organizations can refer to the DoctusTech Learning App to provide clinicians and coders with engaging, self-paced education to master HCC coding and risk adjustment best practices, all while fitting seamlessly into busy schedules.

Week 3: Implementation & Operational Adjustments

 

Organizations begin standardizing screening processes in the third week and refining documentation workflows. This phase ensures that newly implemented practices are seamlessly integrated into day-to-day operations.

6. Standardize Screening 

• • Implement standardized screening protocols for common HCCs.
  • Ensure your organization follows a uniform approach in conducting tests such as PHQ-9 for depression or spirometry for COPD.
  • Remove operational bottlenecks by ensuring necessary tools and resources are available.

7. Establish Documentation Standards

• • Provide clear guidelines on what constitutes an acceptable diagnosis for HCC coding.
  • Train clinicians on evaluative statements and documentation best practices.
  • Address compliance concerns by emphasizing correct coding procedures to
    prevent overcoding.

 

Quick tip: To align with best practices, organizations can reference the CMS Data Principles and Operating Norms, which provide key guidelines on data governance, accuracy, and integration. Establishing standardized workflows based on these principles helps improve documentation quality, streamline coding processes, and enhance compliance across teams.

 

Week 4: Evaluation & Refinement

 

The final week focuses on assessing the effectiveness of the implemented strategies. Organizations can refine their approach and make necessary adjustments to sustain improvements over time by gathering feedback, monitoring performance, and leveraging technology.

8. Implement a Real-Time Feedback Loop

• • Develop a system for clinicians to receive feedback on coding accuracy.
  • Consider leveraging chart reviewers, AI-powered coding tools, or internal audit teams.

9. Leverage Technology for Sustainability

• • Utilize coding support tools such as AI-driven suggestions or workflow automation.
  • Encourage the use of structured templates for more straightforward documentation.
  • Ensure clinicians have access to up-to-date coding resources and guidelines.

Quick Tip: To stay compliant and avoid documentation discrepancies, healthcare organizations can use DoctusTech’s PDAP, an AI-powered tool that enhances RAF accuracy and reduces documentation time. Seamlessly integrating with 70+ EMRs, PDAP streamlines workflows, minimizes errors, and provides real-time alerts for non-compliant notes.

Final Thoughts: Setting the Stage for Long-Term Success

The first 30 days of an HCC coding initiative are critical in laying the groundwork for success. Organizations can ensure improved accuracy, compliance, and financial performance by implementing effective training, standardizing operations, and refining processes. 

 

Also, consider that, beyond the first month, ongoing evaluation becomes essential. Tracking key metrics helps assess the impact of training on clinic revenue, ensuring that education efforts strike the right balance between effectiveness and clinical productivity. Regular performance monitoring allows organizations to measure coding improvements, identify areas needing additional support, and adjust strategies to maintain engagement and effectiveness.

 

A well-structured risk adjustment program not only enhances reimbursement outcomes but also improves patient care through better documentation and diagnosis practices.

 

We know navigating risk adjustment can feel overwhelming, but you don’t have to do it alone. DoctusTech is here to help. Schedule a demo with us today and see how we can streamline your HCC coding initiatives for long-term success.