Your MA Panel Is More Complex Than Your Claims Reflect
Independent physician groups with significant Medicare Advantage panels are leaving documented conditions unreported, not because providers aren’t doing the work, but because the capture process isn’t built to match the complexity of what’s in the chart.
The gap between what’s documented and what’s reported is rarely dramatic. It shows up in problem lists that haven’t been maintained, in documentation that hints at condition management without clearly supporting a diagnosis, in acute resolved conditions still sitting on revalidation lists years later, and in providers coding to habit rather than specificity. A patient managed for hypertensive heart disease with heart failure gets coded as I10. A diabetic patient with multiple complications gets E11.9. The clinical work is real. The risk adjustment value walks out the door.
CMS RADV audits don’t care about intent. They review the documentation behind every submitted HCC. If the chart doesn’t support the code, the payment gets clawed back. In 2026, that exposure is not theoretical; it’s very real, given the current OIG audit focus.
What BCA Does:
Risk Adjustment Coding Review
We analyze diagnosis frequency reports for indicators of low specificity and known problem areas within HCC and CDPS programs. We review revalidation lists for unreported conditions, then follow with targeted documentation reviews to identify conditions documented but not captured in your submitted risk scores.
RADV Audit Readiness
We offer both retrospective review during the open correction period and prospective review before the end of the reporting year. Retrospective work identifies documentation that won’t hold up under CMS scrutiny. Prospective work gives your team time to correct claims when supported or revalidate conditions before the reporting window closes.
Documentation and Process Improvement
We don’t just find the gap, we help you close it. Through process analysis, provider-level training, and workflow recommendations tailored to your EMR, we help your team build sustainable capture habits. Our approach is tailored to your practice, providers, and patient population.
Who is BCA and Why Should You Choose Us?
BCA has been doing this work since 1989. In 2025 we completed a comprehensive risk adjustment analytics engagement with a major payer, conducting data analysis, provider interviews, site visits, and developing detailed work plans across a statewide network of FQHCs. We understand what the data looks like before the chart review and what the chart reveals that the data doesn’t show.
We work with independent groups to figure out your unique opportunities. Our job is to be on your side of the table. We are here to get you audit-ready before the auditor calls.
If your MA panel is significant and your last HCC review was more than 12 months ago, or you’ve never had one, a free 15-minute conversation with us is worth your time.
No commitment. No pitch deck. Just a direct conversation about what we’re seeing in the market and whether it matches what you’re experiencing.