100%
Record review coverage
25%+
Condition capture improvement
40%+
Documentation time reduction
95%+
3rd-party audit accuracy
Service & Technology Approach
The combination that drives accurate reimbursement
Coding expertise, CDI proficiency, and provider engagement — working together to ensure complete and accurate representation of every patient's health status.
Expert coders and physicians review the complete record from preceding calendar years and year-to-date documentation to identify HCC gaps and undocumented conditions, then inform providers using Clinical Documentation Integrity alerts.
The physician-led care team creates a CDI alert notifying providers of previously reported and suspected diagnoses based on clinical indicators — enabling more accurate risk capture and improved HEDIS adherence at time of visit.
A dedicated Provider Consultant conducts weekly site visits, delivers and retrieves CDI Alerts, coordinates provider education sessions, and alleviates administrative burden — so providers can focus on patient care while documentation integrity improves.
How the CDI Alert Works
Three things surfaced at every patient visit
The CDI Alert surfaces previously reported diagnoses, suspected diagnoses from medical record review, and open quality measure gaps — all in one place, at the point of care.
Detailed View
Previously Reported Diagnoses
Suspected Diagnoses
Quality Gap Examples
*Not actual patient data. For demonstration purposes only.
From clinical note to closed quality gap
A sample patient encounter showing how documentation in the visit note flows into the CDI Alert and concurrent review.
HPI
68-year-old female presents for a follow-up visit. No new complaints. Indicates blood sugar has been well controlled. Reports moderate depression symptoms. Labs from last week show an eGFR of 39.
PMH
Type 2 DM, major depressive disorder, CKD, advanced COPD, on home oxygen around the clock.
Medications
Semaglutide, empagliflozin, citalopram, fluticasone/umeclidinium/vilanterol inhaler, albuterol nebulizer as needed.
ROS
Mild shortness of breath with exertion, no worse than baseline. No chest pain or palpitations. Depressed mood and lack of interest in social activities. No suicidal ideation. No nausea or abdominal pain
Exam
Vitals: BP = 123/78 | HR = 74 | RR = 19 |
T = 97.9 | BMI = 29.2
CVS – regular rate and rhythm, no murmurs
Lungs – diminished air entry, mild scattered end expiratory wheezes
Abdomen –no tenderness or distention
Extremities – pulses are palpable, no pitting edema
Neurological – alert and oriented, no deficits
Psych – PHQ-9 score today is 11
A/P
1. Type 2 DM with CKD — well controlled, recheck HgbA1c.
2. Major depressive disorder, recurrent, moderate.
3. CKD — eGFR stable, continue to avoid NSAIDs.
4. Advanced COPD — stable, continue home O2 and inhalers.
*Not actual patient data. For illustrative purposes only.
inpatient offering
Protect fee-for-service reimbursement and improve the accuracy of clinical documentation through secondary chart reviews, DRG optimization, clinical validation, procedural coding review, and physician education.
Secondary Inpatient Chart Reviews:
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Pre-bill documentation review
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DRG optimization
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CC/MCC capture
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SOI/ROM enhancement
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Revenue-recovery opportunities
Clinical Validation Reviews:
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Diagnosis validation
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Medical-necessity support
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Denial prevention
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Audit preparedness
Procedural Coding Reviews:
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Complex surgical coding audits
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PCS coding optimization
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Procedure-sequencing validation
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DRG-impact analysis
DRG Downgrade & Denial Support:
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Clinical appeals support
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Medical-record review
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Root-cause analysis
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Prevention strategies
Provider & Coding Education:
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Targeted physician education
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Service-line reviews
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Documentation best practices
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Coding-accuracy improvement
Built for the priorities of both finance and clinical leadership.
Revenue Cycle & Finance
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Increase CMI
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Improve DRG accuracy
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Reduce revenue leakage
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Improve hospital reimbursement
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Optimize Medicare reimbursement
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Demonstrate CDI
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ROI Recover missed revenue
Clinical Validation Reviews:
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Improve quality scores
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Validate AI findings and Epic/EHR BPAs
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Reduce denials
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Strengthen documentation compliance
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Improve risk-adjustment and HCC documentation
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Support clinical-quality reporting
Outpatient offering
Improve RAF accuracy, quality performance, risk adjustment outcomes, and population health management through proactive chart reviews, quality gap identification, provider engagement, and coding support.
Prospective Risk Adjustment Reviews:
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Pre-visit chart reviews
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HCC-opportunity identification
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Suspect-condition validation
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Provider-ready documentation recommendations
Retrospective Risk Adjustment Reviews:
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Annual-wellness-review support
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Missed-HCC identification
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Coding validation
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RAF optimization
Quality Gap Closure Programs:
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Stars measure support
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HEDIS-gap identification
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Quality abstraction
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Care-opportunity reporting
Provider Engagement & Education:
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Point-of-care guidance
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Documentation coaching
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Coding education
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Workflow optimization
Population Health Documentation Reviews:
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Chronic-disease reassessment
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Problem-list integrity
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Longitudinal condition tracking
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Transition-of-care documentation support
Medication Adherence & Pharmacy Optimization:
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Medication-adherence opportunities
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Pharmacy-trend identification
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Formulary-alignment support
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Consumer-engagement initiatives
ACA, MSSP & Value-Based Care Support:
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ACA risk adjustment
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Medicare Advantage risk adjustment
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MSSP documentation support
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ACO-performance improvement
CONCURRENT REVIEW & QUERIES
1
If A/D is checked for a previously reported or suspected diagnosis on the CDI Alert, and the medical record documentation doesn’t support the diagnosis, a query will be sent back to the provider
2
If A/D is still considered the appropriate response, an amendment or addendum can be made in the medical record within 30 days from the date of service to better support the diagnosis
3
If the provider thinks the appropriate response should have been A/NP or N/A and no changes were made in the medical record, the provider can enter that response to the query on the CDI Alert.
4
Once all documentation in the medical record is finalized by
the provider, including amendments and addenda, the Secondwave coder will perform a final review and abstract any newly supported diagnoses from the medical record.
Closing the gap
Amendment or addendum — either path works
Both approaches give the coder what's needed to abstract the newly supported diagnosis.
Amendment
Original note amended with the additional documentation
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Type 2 DM with CKD — blood sugar well controlled, recheck HgbA1c
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Major depressive disorder — given ongoing symptoms, will refer to psych
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CKD stage 3b — eGFR stable, continue to avoid NSAIDs
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Chronic respiratory failure — continue home O2
Addendum
Addendum added to the record referencing the original note
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Addendum to office note from DOS 01/31 · entered 02/11
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Major depressive disorder — given ongoing symptoms, will refer to psych
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CKD stage 3b — eGFR stable, continue to avoid NSAIDs
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Chronic respiratory failure — continue home O2
Electronically signed by the provider
Service & Technology Approach
The combination that drives accurate reimbursement
Coding expertise, CDI proficiency, and provider engagement — working together to ensure complete and accurate representation of every patient's health status.
RAF 0.631 → 2.014
Poor to complete documentation
Reduced audit exposure
Defensible, documented programs
Reimbursement accuracy
Compliant capture only
True health representation
Accurate severity of illness
Complete documentation through our prospective program results in a RAF score that accurately represents a member's true severity of illness. Toggle to compare.
The cost of incomplete documentation
Poor
Average
Complete
Diagnosis
ICD-10
RAF
76 y/o Female
Demographic
0.465
Diabetes
E11.9
0.166
CHF Not Addressed
—
0.000
CKD Not Addressed
—
0.000
COPD Not Addressed
—
0.000
Total RAF
0.631
RAF Score
Very inaccurate representation — member is twice as healthy as the average Medicare member.
0.631
Quality Assurance
All entries with a code and/or CDI query undergo second-level review by a QA coder. Codes or queries with discrepancies are moved to third-level review by a supervisor. Quarterly third-party audit reviews are performed by PwC, consistently exceeding >95% accuracy.
100%
Accuracy Rate — Third-Party Firm Results, 1Q and 2Q 2024
>95%
Ongoing third-party audit accuracy guarantee
Our compliance commitment
Mandatory compliance and HIPAA training completed annually by all employees. Independent third-party audit validation every quarter. Programs built to stand up to internal review and external audits.
HITRUST certified
HIPAA compliant
AICPA SOC
100% U.S.-based
3–5 years minimum coder experience
WE ARE COMPLIANT WITH