Pre-Bill Documentation Validation: Five Ways High-Performing MA Organizations Reduce RAF Volatility

1. Validate documentation before it moves forward

The lowest-cost time to fix documentation gaps is before review cycles begin. High-performing organizations validate whether diagnoses are defensible while encounters are still recent—when clarification is easy and context is intact.

This prevents late-stage surprises during reconciliation or audit preparation, when fixes are slower and more disruptive.

2. Make supporting evidence visible at the decision point

Risk adjustment teams shouldn’t have to hunt through charts to decide whether a condition will hold up. When evidence is visible alongside the diagnosis, decisions become faster and more consistent.

This reduces internal debate and improves confidence in what moves forward.

3. Evaluate documentation across time, not just one encounter

Many conditions fail review not because evidence doesn’t exist, but because it’s outdated or not clearly tied to the current performance year.

Successful organizations explicitly consider recency and continuity, reducing the risk of submitting conditions that won’t withstand scrutiny.

4. Close documentation gaps while visits are still fresh

Flagging gaps alone doesn’t change outcomes. The organizations that improve documentation quality route clear, timely requests back to providers while encounters are still top of mind.

This reinforces expectations through workflow rather than relying solely on education.

5. Learn from outcomes without adding complexity

Whether gaps are discovered during QA, reconciliation, or audit prep, high-performing teams feed those signals upstream.

This prevents repeat issues and steadily improves documentation quality over time—without adding more review layers.

The payoff: predictability instead of volatility

When documentation is validated earlier, teams spend less time reacting downstream. Audit preparation becomes routine, provider relationships improve, and leadership gains confidence in performance forecasts.