Medical Record Retrieval for Medicare Advantage Plans: Strategic Revenue Optimization Guide

‍

For Medicare Advantage (MA) plan executives navigating the transition to HCC Version 28, medical record retrieval represents far more than administrative compliance. It's the difference between capturing your full CMS reimbursement and leaving millions in risk adjustment revenue unreported. With 62% of MA enrollees having at least one chart review in 2022, chart chase has become an industry standard practice that directly impacts plan profitability.

‍

The stakes are clear. Every undocumented chronic condition represents lost revenue. Every missed historical diagnosis means a lower Risk Adjustment Factor score. And with CMS now auditing 100% of all eligible MA contracts annually, inefficient or incomplete medical record retrieval processes expose plans to both revenue loss and compliance risk.

‍

Understanding Medical Record Retrieval in Medicare Advantage Operations

‍

Medical record retrieval has evolved from a periodic compliance activity into a systematic revenue optimization discipline. Understanding how chart chase functions within the broader MA ecosystem is essential for plans looking to maximize their risk adjustment capture while maintaining regulatory compliance. The process encompasses everything from identifying which records to retrieve through final submission to CMS, with each step requiring careful coordination between clinical, operational, and technical teams.

‍

Definition and scope of medical record retrieval (chart chase)

‍

Medical record retrieval encompasses the systematic process of obtaining patient documentation from provider offices, clinics, and hospitals to identify diagnoses that weren't captured through regular claims submissions. Unlike reactive record requests, strategic chart chase operates at scale, targeting thousands of member records across hundreds of provider organizations to ensure comprehensive risk adjustment data capture.The scope extends beyond simply requesting files. 

‍

Comprehensive medical record retrieval includes:

‍

• Provider outreach
• Document validation
• Clinical review
• ICD-10 code extraction
• Timely submission to CMS through proper channels. 

‍

When executed properly, chart retrieval programs act as both safety net and revenue engine for risk adjustment operations.

‍

Critical role in risk adjustment and HCC coding

‍

CMS doesn't automatically know about every condition your members have. They only recognize what gets documented and properly coded. If a member had diabetes last year but their physician didn't document it this year, CMS assumes that condition is resolved. RAF score drops accordingly, and so does your monthly payment.

‍

Hierarchical Condition Categories translate documented diagnoses into revenue, but HCCs only count when captured from acceptable sources and submitted correctly. Medical record retrieval ensures you're systematically finding those diagnoses in provider documentation. Each diagnosis must meet documentation standards including at least one MEAT element (Monitored, Evaluated, Assessed, or Treated) to substantiate it for risk adjustment purposes.

‍

Financial impact on RAF scores and CMS payments

‍

A Risk Adjustment Factor score directly determines CMS payment amounts per member monthly. A member with a RAF score of 1.0 generates standard capitation, while a member with diabetes, hypertension, and chronic kidney disease could have a RAF of 2.5 or higher, generating more than double the monthly revenue.

‍

In 2023, retrospective chart review submissions added an estimated $24 billion in additional payments to MA insurers. Even small RAF increases translate to significant dollars. A 0.10 increase in RAF (from adding one HCC) could mean roughly $120 more per member per month, or approximately $1,440 annually. Multiplied across thousands of members, comprehensive chart retrieval becomes one of the highest ROI initiatives in plan operations.

‍

The Revenue Impact of Strategic Medical Record Retrieval

‍

Beyond simple documentation compliance, strategic medical record retrieval serves as a powerful financial lever for MA plans. The revenue implications extend across multiple dimensions, from preventing immediate leakage of undocumented conditions to positioning plans advantageously through industry transitions like the V24 to V28 model change. Plans that approach chart chase strategically rather than reactively consistently outperform peers in risk score accuracy and financial outcomes.

‍

HCC recapture opportunities and revenue leakage prevention

‍

Revenue leakage occurs when documented conditions never make it to HCC submissions. Chronic illnesses like diabetes, congestive heart failure, and COPD persist year over year, but if they're not documented in the current year's medical record, the risk adjustment model assumes the patient no longer has that condition.

‍

By examining medical records, 17% of MA enrollees had an undocumented condition identified that raised their risk score and payments. These recaptured HCCs prevent revenue from disappearing due to under-coding. One health plan discovered 579 active chronic conditions weren't captured across 763 patient charts, leading to over $1 million in lost Medicare revenue. Identifying and coding those via retrieval plugged that leakage immediately.

‍

Historical diagnosis documentation requirements

‍

While risk adjustment operates on a 12-month coding cycle, maintaining a 24-month look-back on member health data helps flag chronic conditions requiring recapture. Historical lab values, prior hospitalizations, and medication patterns provide clinical indicators that conditions exist and need current-year documentation.

However, only diagnoses documented during a face-to-face encounter in the current year count for risk adjustment. Lab reports or radiology results alone cannot be directly submitted as diagnoses. They must be referenced in a provider's narrative or problem list in an encounter note. Historical data serves as intelligence for targeting retrieval efforts rather than as submittable codes themselves.

V24 to V28 transition implications for chart chase programs

The shift from CMS-HCC Model Version 24 to Version 28 fundamentally changes medical record retrieval priorities. The new V28 model introduces 115 HCC categories (up from 86 in V24) but drops over 2,200 diagnosis codes that previously triggered HCCs. Many conditions that were high-value retrieval targets under V24 no longer generate revenue under V28.

‍

Industry experts anticipate lower RAF scores on average once V28 is fully implemented in 2026, even with no change in patient health. Chart retrieval programs must be recalibrated to reflect new HCC mappings, with greater emphasis on documentation specificity. Conditions requiring complication coding or severity modifiers become more critical, while previously valuable but less specific codes drop in priority.

‍

ROI calculations for comprehensive retrieval programs

‍

Medical record retrieval typically costs $40 to $50 per chart when using professional services. Against these costs, measure the revenue impact of captured HCCs. Health plans have seen that advanced retrospective reviews increased revenue by $2,000 to $4,000 per member through more complete coding.

‍

A straightforward ROI scenario illustrates the value proposition. If 10,000 charts retrieved at $500,000 total cost yield additional HCCs in 30% of cases, with each adding an average of $1,000 in annual revenue, that's $3 million gained against $500,000 invested. This 6x return (600% ROI) is conservative. 

‍

Technical Infrastructure for Scalable Medical Record Retrieval

‍

Modern medical record retrieval operates on a foundation of sophisticated technical infrastructure that enables plans to retrieve millions of charts efficiently while maintaining data integrity and security. 

‍

The technical architecture must do several things: 

‍

• Support intelligent prioritization
• Have accurate patient matching across disparate systems
• Connect seamlessly with provider EHRs
• Automated workflows that scale during peak seasons 

‍

Plans investing in robust technical infrastructure consistently achieve higher retrieval rates at lower per-chart costs compared to those relying on manual processes.

‍

Enterprise data warehouse integration for retrieval prioritization

‍

Scalable chart retrieval starts with robust enterprise data warehouse integration. By linking retrieval efforts to your EDW, you can analyze which member charts to target and dynamically prioritize requests based on expected ROI. The EDW aggregates claims, encounters, prior chart data, and membership information to identify members with high suspect value.

‍

Advanced plans use predictive models in the EDW to score each member for likely missing HCCs. The output might be a retrieval worklist ranking charts by expected impact. For example, members with multiple chronic conditions but low current risk scores bubble to the top, ensuring resources focus on the highest-value opportunities rather than random chart selection.

‍

EMPI systems for patient identity resolution across providers

‍

Enterprise Master Patient Index systems create unified patient identities that link all corresponding records from different providers. Without proper EMPI implementation, duplicate or mismatched records hamper retrieval efforts. You might request records from two different providers not realizing they refer to the same patient, or worse, pull the wrong patient's chart entirely.

‍

Organizations without EMPI reported about 18% of patient records being duplicates and achieved only 24% match rates when exchanging data externally, whereas those with EMPI achieved over 90% accurate matching. For chart chase programs, this difference between 24% and 90% matching accuracy can make or break retrieval completeness and HCC capture rates.

‍

API connectivity with provider EMR systems

‍

Traditional chart retrieval through fax and mail takes weeks. API connectivity with provider electronic medical record systems changes the equation completely. As of 2022, all ONC-certified EHR systems are required to support FHIR-based APIs for data access, creating standardized pathways for authorized entities to electronically retrieve health data.

‍

Optum reported retrieving over 1.7 million medical charts via direct EHR connections in 2020, with projections to surpass 2 million through digital access. By using APIs, records flow automatically without provider staff intervention, dramatically reducing turnaround time from weeks to hours or days while improving retrieval completeness.

‍

Automated retrieval workflow management

‍

Handling tens of thousands of chart requests requires specialized workflow automation. Modern retrieval platforms coordinate all moving parts from request generation to follow-up and receipt. Automated systems schedule batches of requests, track status in real-time, send reminders at set intervals, and alert staff only when human intervention is needed.

‍

AI-enhanced platforms can process charts in about 8 minutes versus 45 minutes for fully manual review, while achieving higher accuracy rates. Automation dramatically cuts manual file handling time, accelerates coding workflows, and ensures no request falls through the cracks during peak retrieval seasons.

‍

Operational Framework for Effective Chart Chase Programs

‍

Technical infrastructure provides the foundation, but operational excellence determines whether chart retrieval programs actually deliver results. The operational framework encompasses how plans interact with providers, prioritize limited resources, ensure quality and compliance, and maintain audit readiness in an environment of increasing CMS scrutiny. Leading programs balance efficiency with thoroughness, automation with human expertise, and speed with accuracy to create sustainable competitive advantages.

‍

Provider outreach and relationship management strategies

‍

Medical record retrieval success hinges entirely on provider cooperation. Effective programs treat providers as partners rather than simply data sources. Clear communication about purpose is essential. Providers need to understand that risk adjustment ensures plans are funded to care for complex patients, and accurate coding benefits care coordination.

‍

Minimizing provider burden matters tremendously. Consolidate requests rather than sending multiple separate ones. Use digital channels providers prefer, whether that's secure portals, API integrations, or even on-site scanning services that remove workload from office staff. As doctors face unprecedented numbers of records requests for MA risk adjustment, plans that make the process painless achieve significantly better response rates.

‍

Retrieval request prioritization based on RAF impact

‍

Not every medical record carries equal revenue opportunity. Members with multiple chronic conditions or high-impact diagnoses are gold mines for recapture. If a member has diabetes, COPD, and congestive heart failure in their history, ensuring all conditions are documented this year can substantially raise their RAF.

‍

Prioritization algorithms should consider current RAF score, historical HCC presence, suspected conditions based on pharmacy patterns, and provider responsiveness rates. Reviewing roughly 30% of charts (the right 30%) can capture approximately 90% of missed HCCs, demonstrating how strategic prioritization maximizes ROI by focusing resources where they matter most.

‍

Quality assurance protocols for retrieved documentation

‍

Getting medical records is only half the battle. Documentation within those charts must contain usable, compliant evidence supporting HCC coding. Quality assurance catches problems early, whether that's incomplete records, documentation not meeting CMS standards, or clinical information that doesn't support suspected diagnoses.

‍

QA protocols start with document completeness checks, then clinical validation to ensure documentation clearly states diagnoses rather than vague statements. Finally, compliance review ensures documentation comes from acceptable encounter types and provider specialties CMS recognizes for risk adjustment. This multi-layered approach maintains the coding accuracy rates exceeding 95% that plans need for audit protection.

‍

Compliance tracking and audit trail requirements

‍

With CMS now auditing every MA plan annually and reviewing up to 200 records per plan, meticulous tracking is non-negotiable. Every chart request sent should be logged with date, provider information, patient details, and reason. Once retrieved, the audit trail must show who accessed each record, when they reviewed it, what diagnoses were identified, and how those diagnoses were validated before submission.

‍

CMS projected MA plans might be overbilling by $17 billion annually due to unsupported codes. Plans must be able to demonstrate complete documentation support for every submitted HCC. Without comprehensive audit trails, even minor documentation errors like missing signatures can lead to disallowed codes and significant repayments.

‍

Technology Solutions for Medical Record Retrieval Optimization

‍

Selecting the right technology solutions separates high-performing chart chase programs from those struggling with manual inefficiencies. The technology landscape for medical record retrieval has evolved dramatically, with vendors offering everything from basic workflow management to sophisticated AI-powered coding assistance. Understanding vendor capabilities, integration requirements, automation potential, and analytics features enables plans to make informed decisions that maximize both short-term efficiency gains and long-term strategic positioning.

‍

Vendor evaluation criteria for retrieval platforms

‍

When evaluating medical record retrieval vendors, provider network reach stands as the primary criterion. Does the vendor have established connections with a broad network of clinics and hospitals? Can they handle both traditional methods like fax and modern digital methods like direct EHR links? Vendors with national footprints and hundreds of EHR integrations dramatically improve retrieval success rates.

‍

Technology and automation capabilities separate basic from advanced platforms. Look for robust AI and natural language processing features that can scan retrieved charts for suspected codes. Compliance credentials matter tremendously. Ensure vendors have HiTrust certification, SOC 2 Type II audits, and solid audit support capabilities. Ask about their annual chart processing volumes, as vendors retrieving millions of records annually demonstrate proven scalability.

‍

Integration considerations with existing payer systems

‍

Medical record retrieval solutions must integrate seamlessly with existing payer infrastructure, particularly your risk adjustment coding platform and enterprise data warehouse. Integration determines whether retrieved documents flow automatically into coding workflows or require manual transfers that create bottlenecks.

‍

Consider data exchange formats and member identifier mapping. The vendor system must align with your internal member IDs and provider codes, often requiring crosswalk development. Workflow alignment matters equally. Will coders work within the vendor's system or your existing platform? API-first platforms offer more flexibility than legacy systems built on file transfers, enabling real-time data exchange rather than batch processes that create lag.

‍

Automation capabilities for high-volume retrieval

‍

True automation extends beyond electronic request submission to encompass the entire retrieval lifecycle. Advanced systems automatically identify which charts need retrieval by integrating with claims data, then generate and send requests via optimal channels for each provider. Automated mode switching means the system tries APIs first, automatically switching to fax if needed.

‍

Natural language processing represents the frontier of retrieval automation. AI algorithms can scan unstructured doctor's notes to identify HCC-relevant conditions, achieving accuracy levels as high as 98%. This assists coders by pre-highlighting relevant sections rather than forcing them to read every page line-by-line. 

‍

Analytics and reporting for program performance measurement

‍

Robust analytics transform operational data into actionable intelligence. Retrieval progress dashboards should show volume of charts requested versus received, broken down by provider, region, and time period. Real-time visibility into retrieval rates and aged requests enables managers to allocate resources effectively and escalate stalled requests.

‍

HCC capture and RAF impact reports connect operational efforts to financial outcomes. These show how many additional diagnoses were identified through retrieval and their estimated impact on risk scores. 

‍

Provider performance reports ranking providers by response rates and turnaround times help target relationship-building efforts. Cost metrics including cost per chart and cost per HCC captured enable continuous efficiency optimization. Leading platforms provide visualization tools showing trend lines of RAF scores, top missed HCCs, and their dollar contribution to support data-driven program refinement.

Measuring Success and ROI in Medical Record Retrieval Programs

‍

What gets measured gets managed, and medical record retrieval programs require comprehensive measurement frameworks to demonstrate value and identify optimization opportunities. Effective measurement goes beyond simple volume metrics to assess quality, financial impact, compliance readiness, and operational efficiency. Plans that implement robust measurement systems can continuously refine their approaches, justify investments to leadership, and prove their programs deliver sustainable competitive advantages.

‍

Key performance indicators for chart chase effectiveness

‍

Effective measurement starts with the right KPIs. Chart retrieval rate (percentage of requested records successfully obtained) shows how well provider relationships and processes work. Target 80% or higher for established provider relationships. Turnaround time measures average days from request to receipt, with best practice programs achieving averages under 30 days.

‍

HCC recapture rate measures how many previously unreported HCCs were captured via retrieval. Among chronic HCCs members last year, achieving 90% recapture rates indicates excellent performance. Coding accuracy, determined by QA or audits, should exceed 95% to minimize compliance risk while maximizing revenue capture. Track coder productivity as charts reviewed per day, ensuring efficiency gains don't compromise quality.

‍

RAF score improvement tracking and attribution

‍

Tracking RAF score improvement requires comparing baseline (claims-only diagnoses) against final scores after all chart retrieval and coding completes. Proper attribution tags are diagnosed with their source to quantify chart chase impact specifically. By recalculating risk scores with and without supplemental codes, you isolate the exact RAF contribution from retrieval efforts.

‍

Member-level attribution analysis examines which members had chart-retrieved HCCs and how their risk scores changed year-over-year. This granular tracking proves program effectiveness more convincingly than aggregate statistics alone, enabling you to demonstrate precisely how much incremental revenue came from medical record retrieval versus other coding initiatives. Analysis of top diagnoses added via chart reviews and their dollar contribution helps refine future targeting strategies.

‍

Cost-benefit analysis methodologies

‍

Thorough cost-benefit analysis weighs all program costs (vendor fees, internal labor, technology, overhead) against financial benefits from higher risk scores. The primary benefit is increased revenue from CMS. Calculate this by simulating revenue with and without chart chase diagnoses, taking the difference in total risk-adjusted payment.

‍

Sensitivity analysis tests various scenarios because variables like CMS normalization or coding intensity adjustments can affect realized revenue. Include compliance risk mitigation as a benefit since proper documentation helps avoid RADV payment denials. RADV payment denials occur when CMS recoups money after finding that medical records do not support the insurer's reported diagnoses.

‍

When costs typically run $500,000 and benefits reach $3 million or more, the 5:1 to 6:1 ROI makes chart retrieval one of the highest-return initiatives available to MA plans. Track cost per HCC as a key efficiency metric, with successful programs maintaining favorable ratios where each HCC costs $200 to capture but generates $1,000 or more in revenue.

‍

Implementation Roadmap for Enhanced Medical Record Retrieval

‍

Transforming medical record retrieval from a reactive compliance exercise into a strategic revenue optimization engine requires a structured implementation approach. The roadmap must account for current state assessment, phased rollout to manage risk and change, stakeholder engagement across providers and internal teams, and continuous optimization mechanisms. Plans that follow disciplined implementation methodologies achieve faster time-to-value, higher adoption rates, and more sustainable improvements compared to those attempting big-bang transformations.

‍

Assessment of current retrieval capabilities and gaps

‍

Before implementing improvements, conduct an honest assessment of the current state. Document your complete chart retrieval workflow from identifying needs through submission to CMS. Gather past performance data on retrieval rates, turnaround times, costs, ROI, and audit results from the past 1-2 years.

‍

Evaluate existing technology. Are you still using manual fax and spreadsheets? If tools exist, are they underutilized or lacking automation features? Assess your team's capabilities and capacity. Provider network feedback often reveals process gaps invisible from internal perspectives. This comprehensive gap analysis establishes baseline metrics and identifies which improvements will deliver the greatest impact, categorizing gaps into people, process, technology, and compliance areas.

‍

Phased implementation strategy for process improvements

‍

Approach improvements in manageable phases. Phase one focuses on pilot projects and quick wins with low-hanging fruit. Start with technology pilots involving a subset of providers to prove value before full rollout. Implement immediately actionable process changes like eliminating duplicate requests or improving provider communication templates. Establish baseline metrics from pilots to measure against.

‍

Phase two scales successful pilots broadly while standardizing improved processes organization-wide. Deploy technology solutions to all target providers, formalize new workflows as standard practice, and implement needed staffing adjustments. Phase three optimizes performance by addressing remaining bottlenecks, fully integrating with other risk adjustment initiatives, and refining scale for maximum ROI. This phased approach manages risk while building toward fully optimized operations, with each phase proving value before advancing.

‍

Change management for provider and internal stakeholders

‍

Implementing changes affects both external providers and internal teams, requiring thoughtful change management. For providers, communicate early and transparently about what's changing and why. Offer training sessions on new systems with step-by-step guides and dedicated support. Leverage provider relations representatives to reinforce messages and troubleshoot issues personally. Minimize disruption by timing changes around provider workflows and offering transition periods.

‍

For internal teams, involve staff early in planning so they understand rationale and provide input. Provide comprehensive training with ongoing support during initial weeks. Identify change champions who embrace new approaches and can influence peers positively. Address the "what's in it for me" question directly, showing how changes improve daily work rather than just adding tasks. Celebrate incremental wins to build confidence in new systems and maintain momentum through the transition period.

‍

Chart chase vendors

‍

Here are the major players for your "chart chase" implementation roadmap:

‍

• Optum- The largest scale provider, particularly since their acquisition of Change Healthcare. They offer massive national reach and digital-first retrieval.
• Ciox Health (by Datavant) - Often the "boots on the ground" for many other vendors. They are a primary partner for Optum and many large payers for physical and digital chart retrieval.
• Reveleer - Known for their Evidence Validation Engine (EVE). They focus heavily on RADV audit readiness and automating the "chase" through AI.
• Cotiviti - A major payer-focused vendor that combines deep analytics with retrieval services to predict which charts are most likely to yield "MEAT" evidence.
• Inovalon - They provide a cloud-based Electronic Record On Demand service that integrates directly with many EHR systems for 10x faster retrieval.
• DataLink - Their Evoke360 platform is popular for payer-provider collaboration, helping identify and retrieve suspected HCC gaps in near real-time.
• RAAPID - An AI-focused newcomer gaining traction in 2026 for autonomous risk adjustment and high-speed chart review.

‍

Final Takeaways

‍

Medical record retrieval stands as a critical revenue engineering discipline for MA plans navigating the V28 transition and intensified CMS oversight. With chart reviews adding $24 billion annually to MA payments industry-wide, the financial stakes are undeniable. Plans with sophisticated chart chase programs capture millions in incremental revenue while reducing audit risk through comprehensive documentation support.

‍

Success requires the right combination of technical infrastructure, operational excellence, provider relationship management, and continuous optimization. Enterprise data warehouse integration enables intelligent prioritization. EMPI systems ensure accurate patient matching across providers. API connectivity with EHR systems accelerates retrieval from weeks to hours. Automated workflow management scales operations efficiently.

‍

The roadmap is clear: assess current capabilities honestly, implement improvements in manageable phases, prioritize based on RAF impact, maintain strong provider relationships, and measure relentlessly. A chart chase program should evolve from reactive documentation gathering into a proactive risk adjustment optimization engine that systematically captures every dollar a member population generates.

‍

Plans that treat medical record retrieval as strategic capability rather than compliance checkbox will widen their competitive advantage as CMS tightens requirements and the industry fully transitions to Version 28. The difference between leaving money on the table and capturing full reimbursement potential comes down to how well you execute chart chase operations.

‍

Frequently Asked Questions

‍

Who can stitch together the integration between the chart chase and my Enterprise Data Warehouse?

‍

Invene can. We have deep expertise in payer data architecture and clinical system integration. Our team has built scalable EDWs that consolidate fragmented data sources into unified, analytics-ready structures. We also build RPA workflows for EMR systems that lack APIs, so no system gets left out. For MA plans navigating chart chase at scale, we connect the retrieval pipeline directly to your risk adjustment and reporting layers.

‍

What is the difference between medical record retrieval and chart chase?

‍

These terms refer to the same process. Medical record retrieval is the formal industry terminology, while chart chase is the colloquial term commonly used by payer operations teams. Both describe the systematic process of obtaining medical documentation from healthcare providers to validate diagnoses for CMS risk adjustment and HCC coding purposes. The terms are used interchangeably throughout the industry.

‍

How much does medical record retrieval typically cost per chart?

‍

Cost per chart typically ranges from $40 to $50 when using professional retrieval services. However, the key consideration is ROI rather than absolute cost. A single captured HCC can generate $1,000 to $4,000 or more in annual incremental revenue, making even higher retrieval costs economically viable when targeting the right members. Automation and API integration can reduce per-chart costs significantly at scale.

‍

What impact does the V24 to V28 HCC transition have on chart chase programs?

‍

The HCC model transition fundamentally changes retrieval prioritization. Over 2,200 diagnosis codes that mapped to HCCs under V24 no longer do so under V28, and many categories were restructured with different weights. This means conditions that were high-value retrieval targets under V24 may not justify the same effort under V28, while different condition combinations become more important. Plans must recalibrate targeting algorithms and emphasize documentation specificity to optimize for V28 scoring.

‍

How can payers improve provider cooperation with medical record retrieval requests?

‍

Provider cooperation improves through relationship management, process efficiency, and value demonstration. Consolidate requests to minimize disruption, provide clear submission instructions, and make the process as easy as possible through portals or direct integrations. Communicate how accurate documentation benefits providers participating in value-based contracts. Recognize responsive providers while providing support to those who struggle. The goal is making compliance easier than resistance. Also, in your VBC contracts, include it for API access for extra payment. That'll make your life so much easier.

‍

What ROI can MA plans expect from comprehensive chart retrieval programs?

‍

Well-executed chart retrieval programs typically deliver 5:1 to 6:1 ROI or better. Plans spending $500,000 on retrieval and coding often secure $3 million or more in incremental revenue. One large multi-state MA plan recovered $42 million in risk-adjusted revenue within six months of implementing an advanced retrieval program. When targeting the right member populations with proper prioritization, chart chase consistently ranks among the highest-return initiatives available to MA plans.

‍

‍