By IQnewswire 
You hired risk adjustment coding companies to solve a problem. Too many charts, not enough coders, looming deadlines. They promised relief. But six months in, you’re starting to wonder if you traded one set of problems for another.
Here are five warning signs that your external coding relationship isn’t working as well as you thought, and what to do about each one.
Red Flag #1: The Query Rate Keeps Climbing
External coders should get more efficient over time as they learn your documentation patterns. If your query rate is staying flat or increasing months into the relationship, something’s wrong.
High query rates mean one of two things. Either your external coders aren’t learning your organization (which suggests they’re using a general pool model instead of a dedicated team), or your provider documentation really is that bad and nobody told you before.
Ask your risk adjustment coding companies to break down queries by reason. How many are missing MEAT criteria? How many are ambiguous diagnosis statements? How many are provider-specific patterns? This data reveals whether the problem is generalized or concentrated.
If certain providers account for most queries, that’s actually good news. You can target education to those specific doctors. If queries are evenly distributed across all providers, you’ve got a systematic documentation problem that external coding is exposing but not solving.
Red Flag #2: You’re Finding Errors Through Internal QA
If your internal quality assurance process is catching systematic errors from your external coders, their QA isn’t working. You’re essentially paying them to code charts, then paying your internal team to fix their mistakes. That’s expensive.
Common errors to watch for include overcoding (adding HCCs on thin documentation that won’t survive audit), undercoding (missing obvious HCCs that should’ve been caught), and inconsistent application of MEAT criteria across different coders.
When you find systematic errors, document them specifically and demand correction. Don’t accept vague promises to “improve quality.” Ask for root cause analysis: why did this error happen, what process failed, and what changed to prevent recurrence?
If errors persist after you’ve flagged them, your risk adjustment coding companies aren’t taking your feedback seriously. That’s a relationship problem, not a quality problem.
Red Flag #3: Turnover Is Invisible to You
Coder turnover in offshore operations is high, often 30-40% annually. That’s reality. But if your risk adjustment coding companies aren’t proactively telling you about turnover on your account and how they’re managing transitions, they’re hiding it.
You should know when a new coder joins your dedicated team. You should see their training plan. You should have a transition period where their work gets extra QA review. If coders are churning behind the scenes and you don’t know about it, quality is suffering whether you can see it yet or not.
Insist on regular workforce updates. Who’s coding your charts? How long have they been on your account? What’s their experience level? This transparency matters because coder experience directly affects quality.
Red Flag #4: Communication Takes Forever
If getting a straight answer from your risk adjustment coding companies requires multiple emails, days of waiting, and escalation through account managers, the relationship isn’t working.
Good external coding relationships have direct communication channels. Your team can reach their coders (or at minimum, their coding supervisors) quickly when questions arise. Responses come in hours, not days.
If everything goes through an account manager who relays messages back and forth, you’re playing telephone. Information gets lost, context gets missed, and simple questions take three days to resolve.
Push for direct communication channels. If the vendor resists, ask why. The usual excuse is “we want to ensure consistent messaging,” which really means “we don’t trust our coders to talk to clients.” That’s not reassuring.
Red Flag #5: You Can’t Get Audit Support
Here’s the ultimate test of your risk adjustment coding companies: what happens when you get a RADV audit notice?
Good vendors have processes for audit support. They can quickly retrieve the specific evidence that supported each code they assigned. Their coders are available to explain coding decisions. They help you prepare responses to CMS findings.
Bad vendors disappear when audit notices arrive. Suddenly nobody remembers why codes were assigned three years ago. The coders who did the work have left. Documentation wasn’t preserved properly. You’re on your own.
Test this before you actually get audited. Pick a random member from six months ago and ask your vendor to show you the complete audit trail for that member. Every code, every piece of supporting evidence, every coder note. If they can’t produce this quickly, your audit defensibility is compromised.
What to Do About It
If you’re seeing multiple red flags, you have three options. Fix the relationship, switch vendors, or build internal capability.
Fixing the relationship means having hard conversations about performance, demanding specific improvements with timelines, and escalating to vendor leadership if necessary. This works if the vendor is fundamentally good but execution has slipped.
Switching vendors is expensive and disruptive, but sometimes necessary. If the vendor isn’t responsive to feedback or if quality issues persist despite escalation, staying is more expensive than switching.
Building internal capability means accepting that external coding isn’t solving your problem and you need to staff up. This is the right answer if risk adjustment is core to your business.
The wrong answer is accepting poor performance because switching seems hard. Risk adjustment coding companies should make your life easier, not create a different set of problems. If they’re not delivering value, change something.