Draft physician queries when documentation does not support a proposed code, track response deadlines, and route only unresolved or high-risk queries to your compliance auditor.
Coders spend a disproportionate share of their time chasing physicians for documentation clarification, and that query backlog is what slows down claim submission.
when documentation doesn't support a proposed code
Review unresolved or high-risk queries
A proposed risk-adjusting HCC code for chronic kidney disease stage 4 on a Medicare Advantage encounter lacks supporting lab documentation. The physician query went unanswered past the response deadline, so the case routed to the compliance auditor before submission.
Try it — same review surface your operators use, with a representative decision. Nothing here is saved or sent anywhere.
Complex or ambiguous cases, oncology staging, rare risk-adjusting conditions, and compliance sign-off stay with your coders and auditor.
See this workflow against your own queue.
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