Understanding the Key Differences
Concurrent coding occurs during or shortly after a patient visit, allowing documentation and coding teams to collaborate while the clinical context remains fresh. Providers are prompted to clarify or complete documentation in real time, reducing the need for follow-up queries and ensuring that every relevant diagnosis is supported before the encounter is finalized.
Retrospective reviews, on the other hand, take place days—or even weeks—after the visit. CDI and coding professionals revisit closed encounters, identify documentation gaps, and send queries that often rely on memory or assumptions. While they’ve been the traditional standard, this method delays correction and may come too late to support audit defense or prevent lost risk capture.
The fundamental contrast lies in timing. As CMS tightens documentation standards under V28, the ability to act quickly has become the linchpin of compliance strategy.
Where Compliance Risk Lives—and Why Timing Matters
CMS has made it clear that only well-supported diagnoses will count. MEAT documentation—Monitoring, Evaluation, Assessment, and Treatment—is the benchmark for validation. If it’s not in the note, it didn’t happen.
That’s why timing is everything. The further documentation gets from the encounter, the more vulnerable it becomes. Retrospective workflows expose organizations to several risks: forgotten details, ambiguous phrasing that can’t be clarified, and providers too busy to respond to queries. These risks put an HCC—and the associated reimbursement—on shaky ground.
In contrast, concurrent coding catches gaps while the encounter is still active. CDI specialists can clarify documentation while the provider still remembers the context, the rationale, and the clinical significance of a diagnosis.
Benefits of Moving Toward a Concurrent Coding Model
Real-time accuracy becomes a reality when teams work concurrently. Providers are prompted to document chronic conditions precisely, and each HCC is reviewed for MEAT alignment before submission.
Fewer late queries mean less administrative strain. Providers aren’t burdened with queries days after an encounter from which they’ve already moved on. Instead, documentation is addressed while still at the top of my mind, reducing frustration and improving responsiveness.
Another benefit is better provider engagement. Clinicians become more invested in documentation quality when timely feedback is tied to meaningful outcomes, like preventing audit exposure.
Faster chart closure drives performance across the board. Encounters move through the revenue cycle more quickly, RAF scores stabilize, and coding accuracy improves.
Audit preparedness becomes embedded in the workflow. With every encounter documented correctly the first time, organizations can confidently respond to audit requests, knowing that their charts already meet compliance thresholds.
When Retrospective Still Has a Role
Concurrent coding isn’t a magic switch. Some situations still call for retrospective review:
Deep chart audits of historical risk capture
Identification of chronic conditions that weren’t addressed in real time
Performance measurement to compare CDI effectiveness over time
Educational support to identify trends and inform provider training
The key is not to eliminate retrospective processes but to use them strategically, as a secondary check or educational tool rather than as the frontline defense.
Steps to Transition to a Concurrent Model Without Overwhelming Staff
- Start with high-impact encounters. Target visits where risk capture is most valuable: chronic condition follow-ups, annual wellness visits, and transitional care appointments. These encounters often hold multiple HCC opportunities—and documentation gaps.
- Integrate brilliant prompts. Deploy software tools that surface documentation gaps, identify missing MEAT elements, or suggest HCCs based on history without interrupting clinical flow.
- Involve providers early. This isn’t about adding tasks. It’s about improving documentation so providers aren’t asked to revisit it later. Show them how it saves time and reduces disruptions.
- Align coding and CDI teams. Communication between these teams is critical. Shared dashboards, regular case reviews, and integrated workflows ensure everyone works from the same playbook.
- Track outcomes that matter. Don’t just measure the number of codes captured. Monitor changes in query rates, audit readiness, RAF accuracy, and provider satisfaction to assess the impact of your concurrent model.
Common Mistakes to Avoid
Delaying review too long
If documentation review happens days later, you’ve already missed the point. Concurrent means real-time, or as close as possible.
Focusing only on codes, not context
It’s not enough to flag an HCC opportunity. Teams must ensure the narrative supports the code and meets MEAT criteria.
Overloading providers
Too many alerts or irrelevant prompts will disengage even the most compliant clinicians. Keep it focused and valuable.
Failing to align teams
Without coordination, CDI and coding teams may duplicate efforts or contradict each other.
Neglecting training
Prospective and concurrent models require a shift in mindset. Ensure staff understand not just what to do, but why it matters.
Building Real Trust
This isn’t theory—it’s reality for clinical documentation teams managing high-volume outpatient workflows under scrutiny. Coding managers are balancing speed with accuracy, and CDI leaders are looking for ways to drive compliance without adding burnout. Prospective models like concurrent coding offer a strategic middle ground: timely support, real-time feedback, and better audit protection without increasing documentation burden.
Reiterate the Value of Timely Documentation
In a high-volume outpatient environment, timing isn’t just a workflow preference—it’s a compliance safeguard. Organizations that rely solely on retrospective reviews often find themselves racing to correct what could’ve been addressed in real time. Concurrent coding offers a brighter, more collaborative path—supporting accuracy, reducing friction, and helping CDI teams deliver cleaner documentation. As audit scrutiny rises and CMS expectations tighten, the proper process ensures that outpatient CDI remains compliant and sustainable.
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