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AI-Powered Risk Adjustment for Better HCC Capture

Chart prep, documentation, and coding validation eat hours every week. Kip connects the clinical context so AI Labor can search, rank, and surface evidence, freeing your chart preppers, providers, and coders to focus on the decisions only they can make.

  • CKD stage 3Not addressed since 2024
  • DiabetesRAF 0.302
  • Major depressionEvidence: prior claim
  • Vascular diseaseSuspect: statin + prior imaging

What Kip finds

See it work, chart by chart

Every item arrives as a piece of work with its evidence attached, ready to accept, reject or edit.

Open gaps from last year Conditions addressed before but not yet recaptured this year.
New suspects Conditions the clinical picture supports but no one's coded yet.
Related conditions worth a second look Clinically relevant, doesn't move the RAF score, still worth a clinician's eye.
Problem list cleanup Conditions mentioned in notes but missing from the official problem list.

WorklistOpen gaps · 2 of 14

Chronic heart failureI50.32

  • RAF0.284
  • Last coded01/2024, cardiology follow-up

EvidencePrior-year HCC history

AcceptRejectEdit

Diabetes with complicationE11.22

  • RAF0.302
  • Last coded06/2024, primary care visit

Inside the workflow

Kip doesn't just flag charts. It tells you why.

Every item Kip surfaces is one of four kinds, and each carries its own evidence.

  • EHR
  • Claims
  • HIE
  • ACO & external data
Open gaps from last year New suspects Related conditions worth a second look Problem list cleanup

Your team accepts, rejects, or edits every one. Nothing submits to the chart without a human decision.

See Risk Adjustment in Action

How DoctusTech solves Risk Adjustment

From scattered clinical data to a validated chart

Kip pulls the relevant history together. AI Labor puts it in front of the right person at the right step.

01 Pre-visit Chart preparers
02 Point of care Providers
03 Post-visit Coders & compliance

Kip ranks HCC gaps by RAF value and last-coded date, and surfaces evidence buried in old notes.

Chart preparers: review, prioritize, decide.

Chart prep queueRanked by RAF

  • Diabetes with complication RAF 0.302 Last coded 06/2024
  • Chronic heart failure RAF 0.284 Last coded 03/2024
  • CKD stage 3 RAF 0.069 Evidence in a 2023 nephrology note
4x Operational capacity
92% HCC recapture

Put AI Labor to work across Risk Adjustment

See how Kip increases capacity and moves your team from clinical information to validated, audit-ready work.

Book a Demo

Risk Adjustment, answered

Risk Adjustment accounts for differences in patient health status and expected healthcare needs. In Medicare Advantage, documented diagnoses and other patient information contribute to the risk scores used to estimate expected costs, which is why clinical documentation and coding accuracy matter.

Medicare Advantage plans submit member demographic and diagnosis data to CMS, which calculates a risk score for each member. Conditions must be documented and coded each year to be counted, so recapture of chronic conditions is an annual workflow, not a one-time task.

Hierarchical Condition Categories group clinically related diagnoses within applicable Risk Adjustment models. A Risk Adjustment Factor score represents a patient's expected cost relative to a benchmark population, based on documented conditions and other applicable factors.

HCC coding translates documented conditions into the diagnosis codes used by applicable Risk Adjustment models. Each coded condition needs supporting clinical documentation, which is why coding and documentation are reviewed together rather than in sequence.

AI can rank gaps by value and recency, surface evidence buried in prior notes, and attach that evidence to each item it raises. That removes searching from chart prep, documentation and validation. The clinical and coding decisions stay with the team.

Kip builds a longitudinal patient picture from the EHR, claims, HIE and other connected sources, then coordinates AI Labor across chart preparation, point-of-care documentation, HCC coding and validation. Every surfaced item carries its supporting evidence and every one is accepted, rejected or edited by a person.