Member clinical review
Transform the Way You Document Care
Accurate and specific documentation is at the heart of delivering quality patient care, ensuring compliant coding, and effective risk adjustment. Our Member Clinical Review program provides healthcare providers with personalized Clinical Chart Review and Clinical Documentation Review services designed to strengthen documentation practices, improve ICD-10 Coding Review accuracy, support HCC Coding Review, and identify Documentation Gaps that may impact reporting and reimbursement.
Led by experienced clinical reviewers, this service offers direct, structured Provider Feedback designed to elevate both accuracy and confidence in clinical documentation. Through comprehensive Medical Chart Reviews, providers gain valuable insights that support documentation improvement, coding precision, and Risk Adjustment Documentation.
How It Works
Our Member Clinical Review process begins with a comprehensive Clinical Chart Review of a high-acuity patient chart selected by your provider or organization. This Medical Chart Review includes a detailed evaluation of the complete patient record, including labs, consult notes, imaging reports, progress notes, and supporting clinical documentation.
The review is designed to identify documentation improvement opportunities, strengthen ICD-10 Coding Review specificity, support HCC Coding Review accuracy, and improve Risk Adjustment Documentation.
Documentation & Coding Opportunities Identified During Clinical Chart Review
During each Clinical Documentation Review, our team identifies opportunities that may improve coding accuracy, HCC capture, documentation quality, and Risk Adjustment Documentation performance.
Key Areas Identified
- Inferred or embedded diagnoses were not documented despite clinical indicators
- Nonspecific ICD-10 codes that may impact coding accuracy
- Acute conditions are misdocumented in outpatient settings
- Missed clinical correlations based on pathophysiology
- HCC Coding Review opportunities that may affect risk adjustment reporting
- Documentation Gaps impacting coding and compliance
- Guidance on documentation hygiene based on clinical and coding standards
Following the review, we conduct a 30–60 minute session with actionable insights tailored for the provider and the provider’s team, including coders, medical assistants, and practice staff. A digital summary of findings and recommendations is also provided for ongoing reference and documentation improvement.
Program Options
Single Chart Review & Feedback
Prefer a one-time, in-depth Clinical Chart Review?
Our Single Chart Review option includes a comprehensive Medical Chart Review of 15 patient charts designed to identify Documentation Gaps, coding opportunities, HCC Coding Review opportunities, and areas for Clinical Documentation Review improvement.
Option 2
3-Month Feedback Program
Our 3-Month Member Clinical Review Program combines ongoing Clinical Documentation Review, Provider Feedback, ICD-10 Coding Review, and HCC Coding Review to support continuous documentation improvement.
Month 1 – Identifying High-Acuity Cases
Chart Review: Comprehensive review of 12 high-acuity patient charts selected by your provider or organization. This includes evaluation of full patient records, including labs, consult notes, imaging, progress notes, and supporting documentation.
1:1 Session: A 30–60 minute individualized session with your provider or team to present actionable insights and highlight key findings.
Digital Deliverable: A written summary report outlining findings, Documentation Gaps, coding opportunities, and recommendations for ongoing improvement.
Month 2 – Comprehensive Chart Review
Chart Review: Detailed Clinical Chart Review of 10 patient charts, including full patient records, laboratory results, consult notes, imaging reports, progress notes, and supporting documentation.
1:1 Session: A 30–60 minute individualized session with your provider or team to present actionable insights and highlight key findings.
Digital Deliverable: A written summary report capturing Documentation Gaps, ICD-10 Coding Review findings, HCC Coding Review opportunities, and recommendations for continuous improvement.
Month 3 – Personalized Feedback Sessions
Chart Review: Focused Medical Chart Review of 7 patient charts, including full patient records and supporting documentation.
1:1 Session: A 30–60 minute individualized session with your provider or team to present actionable insights and highlight key findings.
Digital Deliverable: A written summary highlighting findings, strengths, documentation opportunities, and tailored recommendations for ongoing improvement.
Month 4 – Complimentary Q&A 1:1 Feedback Session
Additional support to reinforce documentation improvement strategies, answer provider questions, and discuss progress made throughout the program.
Why Choose This Program?
Improve clinical documentation accuracy
Strengthen ICD-10 coding specificity
Support accurate HCC coding capture
Identify Documentation Gaps and coding opportunities
Improve Risk Adjustment Documentation
Receive personalized Provider Feedback
Support compliance and reporting accuracy
Free follow-up support to encourage lasting improvement
Improve Documentation. Strengthen Coding Accuracy. Support Better Patient Care.
Invest in smarter documentation practices that support compliance, improve coding accuracy, strengthen Risk Adjustment Documentation, and help healthcare providers deliver better patient care.
FAQ
Frequently Asked Questions
What is a Member Clinical Review at CoDoc Academy?
CoDoc Academy’s Member Clinical Review is a personalized clinical chart review service designed to help healthcare providers improve documentation quality, coding accuracy, and risk adjustment performance. Our reviewers analyze patient charts to identify documentation gaps, missed diagnoses, ICD-10 coding opportunities, and HCC capture opportunities. Providers receive a one-on-one feedback session along with a written summary of findings and recommendations.
What is a clinical chart review and why do providers need one?
A clinical chart review is a structured evaluation of patient medical records to ensure diagnoses are documented accurately and completely. For providers participating in value-based care or Medicare Advantage programs, accurate documentation supports coding accuracy, risk adjustment, compliance, and appropriate reimbursement. Chart reviews help identify missed documentation opportunities before they impact reporting and performance.
What types of documentation problems does CoDoc Academy identify during a chart review?
Our reviewers commonly identify documentation gaps, nonspecific ICD-10 codes, missed HCC opportunities, incomplete diagnosis documentation, and clinical conditions that may not have been fully captured. The goal is to help providers improve documentation quality, coding accuracy, and risk adjustment performance while maintaining compliance.
How does the 1:1 provider feedback session work?
After the chart review is completed, CoDoc Academy conducts a 30–60 minute feedback session with the provider and their team. During the session, we review findings, discuss documentation opportunities, answer questions, and provide practical recommendations. Providers also receive a written summary report for future reference and ongoing improvement.
What is the difference between the Single Chart Review and the 3-Month Program?
The Single Chart Review provides a one-time assessment of documentation quality and coding opportunities across 15 patient charts. The 3-Month Program offers ongoing chart reviews, provider feedback sessions, and written reports over multiple months to support continuous documentation improvement and long-term provider education.
Who should participate in CoDoc Academy's Member Clinical Review program?
This program is designed for primary care providers, healthcare organizations, and clinical teams participating in Medicare Advantage, ACO, and value-based care programs. It is especially valuable for practices seeking to improve documentation quality, coding accuracy, HCC capture, and risk adjustment performance.
