Introduction: the cost of one unsupported diagnosis
In risk adjustment, the most costly error is not a missed code. It is an unsupported code that fails review.
Suppression prevents that failure before it happens by keeping only defensible diagnoses in motion.
1. Risk‑bearing contracts reward accuracy, not volume
RAF performance depends on current‑year, encounter‑linked evidence.
When documentation is ambiguous, the safest and most defensible action is to suppress until support is clear.
2. Suppression is a guardrail, not a failure
Suppression protects your organization from audit exposure and extrapolation risk.
It prevents teams from shipping a diagnosis that cannot be defended tomorrow.
3. Transparency turns suppression into trust
Suppressed diagnoses should never disappear. They should remain visible with a clear reason.
The system should answer: what is missing, and what would make this promotable?
4. Make the path to promotion obvious
Providers and coders should see exactly what CMS would need to see: current‑year encounter, MEAT evidence, specificity, and signature.
When that path is explicit, suppression becomes a proactive workflow step, not a dead end.
5. Leaders should measure prevented risk
A suppression rate paired with promotion reasons shows how much risk is being avoided.
This is often more valuable than a raw count of suggested diagnoses.
6. Suppression reduces provider friction
Clinicians trust systems that protect them from ambiguity.
Clear suppression logic reinforces that the goal is defensible documentation, not aggressive capture.
CTA
If suppression feels like lost revenue, your standards may not be visible enough.
Build transparency and you will see suppression as protection, not loss.
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