You hired risk adjustment companies to solve a problem. Maybe you needed coding capacity. Maybe you wanted better technology. Maybe you were trying to improve capture rates. Six months in, you’re not seeing the results you expected.
Before you start the painful process of switching vendors, understand why most risk adjustment company relationships fail. Because often the problem isn’t the vendor. It’s how you’re managing the relationship.
You Didn’t Define Success Clearly
Most organizations sign contracts with risk adjustment companies without defining specific, measurable success criteria. They have vague goals like “improve documentation” or “increase HCC capture” without quantifying what improvement actually looks like.
This creates inevitable disappointment. You think the vendor underperformed. They think they delivered exactly what was promised. Neither of you is wrong because success was never defined precisely.
Fix this by establishing clear metrics before implementation. Not just “improve capture rate,” but “increase capture rate from 3.8 to 4.2 within 12 months.” Not just “reduce audit risk,” but “achieve clean findings on 95% of charts during internal audit simulation.”
These specific targets let you measure whether the relationship is working. They also give the vendor clear goals to work toward instead of guessing what you want.
You’re Not Providing Good Data
Risk adjustment companies can only work with the data you give them. If your chart retrieval process is chaotic, if your EHR extracts are incomplete, if your claims files are weeks out of date, the vendor can’t perform.
I’ve seen organizations blame their risk adjustment companies for poor results when the real problem was that charts were arriving three months late with pages missing. No vendor can code charts they don’t have or can’t read.
Take ownership of your data quality. Make sure charts are complete before submission. Verify that EHR integrations are working properly. Confirm that you’re sending claims data on schedule. If the vendor keeps asking for information you should’ve provided upfront, that’s your problem, not theirs.
You Treat Them Like a Vendor, Not a Partner
Most organizations interact with their risk adjustment companies through formal channels. Monthly status calls. Quarterly business reviews. Everything goes through account managers. Questions take days to get answered.
This transactional approach kills performance. The vendor’s team can’t understand your specific needs if they never talk to your actual staff. Your coders can’t get quick answers to urgent questions. Problems fester because nobody wants to escalate through formal channels for issues that should be resolved in five minutes.
The best vendor relationships have direct communication between operational teams. Your coding supervisor can ping their coding supervisor directly. Your IT team can work with their IT team to troubleshoot integration issues. Problems get solved in real time instead of waiting for the next scheduled meeting.
Push for this level of access. If your risk adjustment companies resist direct operational communication, ask why. Good vendors want their teams talking to your teams because it makes everyone more effective.
You’re Not Giving Useful Feedback
When you find problems with vendor work, how do you communicate them? Most organizations send vague complaints: “We’re seeing quality issues” or “The documentation isn’t meeting our standards.” That’s not actionable feedback.
Risk adjustment companies can’t fix problems they don’t understand specifically. Instead of “quality issues,” send them actual examples: “Chart XYZ coded diabetes based on problem list only, without documented MEAT criteria. This pattern appeared in 12% of diabetic patients reviewed this month.”
That’s actionable. They can identify which coder made the error, retrain them, and implement additional checks for diabetes specifically. Vague complaints about quality just frustrate everyone.
You Haven’t Invested in the Relationship
Most organizations spend months evaluating risk adjustment companies before signing. Then they expect the vendor to magically understand their needs without ongoing investment.
But vendor relationships require continuous work. Regular feedback on what’s working and what’s not. Training sessions where you explain your specific documentation patterns. Joint reviews of complex cases to align on coding philosophy. Process improvements based on lessons learned.
Organizations that treat vendor management as a set-it-and-forget-it activity get mediocre results. Organizations that actively manage their vendor relationships get dramatically better outcomes with the same vendors.
When Switching Actually Makes Sense
Sometimes the relationship really is broken beyond repair. Here’s when switching makes sense.
When the vendor isn’t responsive to clear, specific feedback. If you’ve documented problems, proposed solutions, and escalated appropriately, but nothing changes, the vendor isn’t taking you seriously.
When there’s fundamental misalignment on coding philosophy. If you want conservative coding to minimize audit risk and they code aggressively, that’s not fixable through better communication.
When technology or process limitations prevent them from meeting your needs. If their platform can’t integrate with your systems or their workflow can’t scale to your volume, no amount of relationship management will fix structural problems.
But before you switch, make sure you’ve actually tried to fix the relationship. Define success clearly. Provide good data. Enable direct communication. Give specific feedback. Invest in making it work.
Most vendor relationships that fail could’ve succeeded with better management. Switching is expensive and disruptive. Fix what you can fix before you make that decision.