By Prime Star 
I’ve watched health plans spend millions on retrospective chart reviews, hiring armies of coders to dig through last year’s encounters, only to discover problems they can’t fix anymore. It’s like getting a financial audit that tells you about mistakes from 18 months ago. Sure, the information is interesting. But what are you supposed to do about it now?
Concurrent coding changes this equation completely. Instead of reviewing old charts when it’s too late to act, you’re validating documentation and coding accuracy while the encounter is still fresh. The difference isn’t subtle. It’s the difference between findings a leak after your basement floods versus catching it when the first drops hit the floor.
What Makes Concurrent Different
Traditional retrospective review happens way too late. You wait until December to start reviewing January encounters. By the time you identify a documentation gap, the provider barely remembers the patient. Good luck getting them to clarify whether they actually assessed that CHF or just copied it forward from the problem list.
With concurrent review, you’re intercepting encounters within days or weeks. Your coding team reviews the documentation before the claim finalizes. When they spot a problem (and they will), there’s still time to fix it.
Here’s what that looks like in practice. A provider sees a patient with diabetes, COPD, and heart failure. The note mentions adjusting the patient’s Lasix and checking oxygen saturation, but there’s nothing about the diabetes. No A1C discussion, no medication review, no blood sugar check. In a retrospective model, you discover this eight months later. Too late. In a concurrent model, you catch it within a week and send a simple query: “Can you clarify whether you addressed the diabetes during this visit?”
The provider responds (because they actually remember the encounter), adds the missing documentation, and you’ve just saved an HCC that would’ve been lost forever.
The Revenue Impact Nobody Talks About
Most discussions about concurrent coding focus on efficiency gains. Yes, coders work faster when they’re not hunting through ancient records. That’s nice. But the real money is in the adds.
Adds are documented conditions that never made it onto the claim. The classic example is a detailed progress note about managing chronic kidney disease that somehow doesn’t generate a CKD diagnosis code. In retrospective review, you find these months later and can try to recapture them next year. Maybe. In concurrent review, you find them before the claim goes out and capture the revenue this year. Guaranteed.
One regional health plan I know implemented concurrent review for just 20% of their Medicare Advantage population as a pilot. They found adds on 18% of reviewed encounters. That’s nearly one in five charts where they were leaving money on the table. After 90 days, they expanded to their entire book of business. The math wasn’t even close.
The Compliance Angle
Here’s something that keeps CFOs up at night: deletes. These are codes that got submitted without adequate documentation support. In an audit, each delete can cost you thousands of dollars. If CMS extrapolates, you’re looking at massive clawbacks.
Retrospective review finds deletes after you’ve already submitted the claim and gotten paid. You can correct them, but you’re reporting an error that’s already on CMS’s books. Concurrent review catches deletes before submission. The claim never goes out dirty. You’re building an audit-defensible book of business from day one instead of trying to clean it up after the fact.
Think about that difference during your next RADV audit. CMS pulls a sample of your charts. With retrospective-only review, you’re hoping your coders caught everything important last year. With concurrent review, every chart has been validated before submission. You sleep better.
Provider Relationships Get Better, Not Worse
There’s a myth that concurrent review annoys providers with constant queries. The opposite is true. Providers hate getting queries about encounters from six months ago. They don’t remember the details, they’re busy with current patients, and the whole interaction feels punitive.
Concurrent queries are different. You’re contacting them about a visit from last week. They remember the patient. The conversation is quick and specific. “Your note mentioned worsening CHF symptoms but didn’t document your clinical assessment or plan. Can you add that?” Done.
Over time, providers learn what good documentation looks like because they’re getting immediate, relevant feedback. Documentation quality improves at the source, which means fewer queries down the road. It’s a virtuous cycle instead of the vicious one you get with retrospective-only review.
Making the Shift
You can’t flip a switch and go from retrospective to concurrent overnight. You need data feeds that give you access to encounters quickly. You need workflows designed for speed without sacrificing accuracy. You need buy-in from your provider network.
Start small. Pick one provider group or one high-risk population. Run concurrent review alongside your existing process for 60 days. Measure everything: how many adds did you find, how much faster were your reviews, how did providers respond, what was the revenue impact?
The numbers will tell you whether to expand. In my experience, they always do. Because once you’ve seen what it’s like to fix problems in real time instead of discovering them too late, you can’t go back. Reviewing charts after the fact starts to feel like reading yesterday’s news. Interesting, but not particularly useful.
Risk adjustment done right means catching problems when you can still do something about them. That’s what concurrent coding delivers.