Get paid for the conditions you actually treat. Prove the ones you were paid for.
Risk adjustment is two problems wearing one name. One is risk you took and revenue you earned but never captured. The other is revenue you captured and must continue to verify and document going forward. Most programs are built to chase the first and are quietly exposed on the second. Alberto works both sides of the same ledger.
Worklists a physician’s office can actually act on
Every opportunity carries the three things that decide whether anyone works it: whether the documentation already exists or a visit is needed, where the condition currently stands with CMS, and how strong the underlying evidence is. Those are separate questions and the platform keeps them separate, because a list that mixes “submit this today” with “somebody needs to see this patient” gets worked at the speed of the slowest row.
Prospective suspects are checked against what is already in flight, so nobody is chased twice for a condition already on its way to CMS.
The deadline is part of the finding
A condition that dropped off is not one thing. Sometimes a visit this year restores it. Sometimes only documentation you already hold can still be submitted, and only until the payment year closes. Sometimes the year is settled and the money is gone — and putting that row on a chase list wastes the one resource a risk-adjustment program can’t buy more of.
Alberto classifies every opportunity by which of those it is, and names the federal run it checked to say so.
Chart review that produces an instruction, not an opinion
A coder works one member at a time with the chart open, dispositions each condition, and the decision routes itself to whoever executes it — a submission instruction, a record correction, a question back to the physician, a request for a chart.
The controls are the product. Removing a diagnosis the payer has already paid for requires a second reviewer’s approval, enforced by the database and not by a screen. Adding a condition with no documentation in the chart requires a stated basis, recorded. A second coder cannot silently overwrite the first. Asking a physician and instructing one are different actions, because a leading question taints the documentation it produces.
Most of what a chart review finds is worth nothing, and the product says so
Duplicates within a condition family, conditions superseded by a more severe one already being paid, and conditions already credited are removed before a reviewer ever sees a row. In practice that removes the large majority of raw findings.
The un-netted number is never shown anywhere in the platform. Money to gain, money at risk and money in question are reported in three separate directions and never added together, because their sum doesn’t mean anything. Programs that quote the gross number lose credibility with their own finance team exactly once.
Diagnosis-to-condition mapping runs against the current federal model, and another party’s condition numbers are re-mapped through it before anything is compared — the model versions reuse the same numbers for different conditions, which is how two accurate reports end up disagreeing. Every comparison the platform publishes is like-for-like by construction.
Bring the worklist you’re working today. We’ll show you what ours says about the same members.