By StingFellows 
Selecting a risk adjustment partner isn’t just about comparing software features—it’s about protecting revenue, easing the pressure on clinical teams, and ensuring long-term compliance. With CMS audits intensifying, leaders can no longer afford vague promises or “black box” platforms. Before signing with any vendor, it’s worth asking questions that reveal whether they can truly deliver on accuracy, transparency, and audit defense. The right choice may also mean safeguarding your organization with a purpose-built RADV Audit Solution.
- How Transparent is the Technology?
If a vendor’s platform produces results without showing the “why” behind them, consider that a red flag. In healthcare, every HCC code must be backed by clear evidence. Ask whether the system links each recommendation directly to MEAT criteria in the patient record. Transparency not only builds trust but also arms your compliance team with defensible proof if an audit occurs.
- Does It Integrate with Existing Workflows?
The last thing physicians or coders need is another platform that forces them to toggle between screens. Look for solutions that integrate directly into the EHR. Ask vendors to demonstrate how their system surfaces insights at the point of care without disrupting the provider’s natural workflow. A strong solution reduces chart review time and increases accuracy—without burning out your teams.
- What Safeguards Exist Against Compliance Risk?
Audit pressure is no longer hypothetical. With extrapolation in play, even small errors can lead to staggering clawbacks. Ask vendors how their technology mitigates risks related to overcoding, undercoding, and incomplete documentation. A credible partner should provide not just technology but explainable AI logic, ensuring compliance officers can confidently defend every submission.
- Can the Vendor Demonstrate Proven Outcomes?
Many platforms advertise AI-driven capabilities, but proof matters. Request case studies, pilot results, and measurable data—such as percentage increases in recapture rates, reductions in chart review time, or revenue lift achieved by other health plans. Technology alone doesn’t move the needle; evidence of consistent outcomes does.
- How Flexible is the Engagement Model?
Healthcare organizations have different needs based on size, resources, and regulatory exposure. A one-size-fits-all approach rarely works. Ask whether the vendor offers options ranging from workflow tools for internal teams to fully managed services backed by expert auditors. This flexibility can help your organization start where it’s most comfortable and scale as requirements evolve.
- What is the Long-Term Value Beyond Compliance?
Finally, think beyond the audit cycle. The best partners help you not only pass audits but also optimize prospective risk adjustment, support care gap closure, and boost physician productivity. This long-term impact—reducing abrasion, safeguarding revenue, and improving patient outcomes—is what separates a true partner from a transactional vendor.
Choosing the right risk adjustment partner is ultimately about confidence: confidence that your data is accurate, your teams are supported, and your organization is audit-ready. As you evaluate vendor technology, these questions will help you move past surface-level features to uncover whether a partner can provide both defensibility and financial strength. In a world where CMS scrutiny is rising, the right partner—and the right RADV Audit Solution—can make the difference between costly clawbacks and sustainable success.