Case Study: Multi-Site VBC Network Stabilizes RAF and Improves Audit Readiness

Customer profile

A multi-site value-based care organization managing Medicare Advantage populations across 12–25 clinics and multiple provider groups.

Teams involved included risk adjustment operations, coding/CDI, compliance, and clinical leadership.

Challenge

The organization saw increasing volatility in risk adjustment results. Providers documented chronic conditions, but some diagnoses were later excluded or downgraded during chart review due to incomplete or outdated MEAT support.

They lacked a reliable way to identify documentation gaps early—before submission cycles, reconciliation, and RADV preparation—leading to chart chasing and last-minute scramble ahead of audit season.

What they tried before

The team previously relied on end-of-year chart sweeps, manual coder queries, and point tools that flagged issues without connecting diagnoses to encounter-linked evidence.

These approaches were reactive and didn’t create a consistent workflow for defensible documentation before submission.

Implementation

SynchroLink AI was deployed as a pre-bill documentation validation layer without requiring an EHR rip-and-replace.

The pilot focused on high-impact chronic conditions and a defined set of clinics, then expanded as workflows stabilized.

• Configured high-risk prioritization and review workflows for coding/CDI and compliance.
• Connected chart artifacts (notes, labs, meds, problem list, encounter metadata) to evidence views.
• Established closed-loop routing back to providers for missing documentation support.

What SynchroLink AI did in the workflow

SynchroLink AI reviewed charts prior to submission, surfaced diagnoses with weak or missing MEAT support, prioritized high-risk patients, and packaged evidence into audit-ready views.

• High-risk modal to focus attention on the patients that matter most.
• Diagnosis validation panel and patient coding overview to separate supported vs. risky diagnoses.
• MEAT Evidence modal (Evidence & MEAT tab) with encounter-linked artifacts.
• MEAT timeline to show evidence across time for defensibility.
• Notify Provider modal to route documentation tasks while visits were still fresh.
• Audit pack generation to package evidence quickly when reviews occur.

Results

Within the first 60–90 days, teams reported fewer unsupported conditions flowing into downstream review cycles and fewer last-minute documentation scrambles ahead of audit season.

Coding/CDI teams spent less time chasing chart artifacts because evidence was visible at the point of decision.

Leadership gained clearer visibility into where RAF volatility was coming from and where documentation workflows needed reinforcement.

Why it mattered

By 2026, risk-bearing organizations win by reducing risk, shortening cash cycles, surviving audits, and protecting margins.

SynchroLink AI helped shift the organization from reactive chart chasing to proactive, defensible documentation before submission—improving audit readiness and reducing volatility.