Introduction: RAF resets every year, but most workflows don’t
Chronic conditions do not carry over in risk adjustment. If a condition is not supported in the current year, it falls out.
That is why recapture is not optional. It is the primary control for audit‑ready RAF stability.
Redocumentation and continuity recapture make current‑year support visible before submission, when it is still fixable.
1. Why recapture breaks down in practice
Most teams rely on manual chart review. That catches some items but misses the conditions that are documented inconsistently or spread across encounters.
By the time gaps are discovered, visits are old and fixes are expensive.
The result is silent RAF drift rather than a clear signal.
2. Continuity is a standard, not a suggestion
CMS expects current year support from face to face encounters with MEAT evidence and provider signature.
Continuity is proven by encounter history, not problem lists or inference.
If evidence is not encounter‑linked and visible, it is not defensible.
3. Redocumentation works when it is focused
Recapture does not mean reviewing everything. It means focusing on high impact chronic conditions and the patients most likely to drop off.
A dedicated redoc queue turns last year HCCs into this year action, without adding noise for clinicians.
When coders see only what must be recaptured, throughput rises and recapture becomes predictable.
4. Continuity timelines reduce ambiguity
A timeline of encounter dates makes current‑year support obvious at a glance.
When a condition lacks a recent encounter, the gap is clear and actionable.
This replaces guesswork with visible proof.
5. Suppression protects RAF (it does not reduce it)
Suppression is a feature because it blocks unsupported diagnoses from moving forward.
The key is transparency: suppressed items remain visible with a clear reason and a path to promotion.
That builds trust and prevents silent undercoding.
6. Leadership needs recapture visibility, not just volume
Contract‑level rollups should show which conditions are current‑year supported, at‑risk, or missing.
This keeps recapture efforts aligned to RAF impact and audit exposure.
The goal is a stable, defensible RAF picture by mid‑year, not a scramble in Q4.
7. What to measure
Recapture rate, continuity coverage, and RAF lift per patient are the metrics that show ROI.
When you can connect recapture to modeled revenue impact, prioritization becomes obvious.
CTA
If recapture feels chaotic or late, the workflow is the issue, not the team.
Pressure‑test your redoc flow and make current‑year support visible before submission.
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