April 3, 2026
The Risk Adjustment Tool Gap Why Finding Codes and Proving Codes Are Two Different Jobs
Finding Codes Was Never the Hard Part NLP has been able to identify diagnosis mentions in clinical notes for years. The technology to scan a chart and surface potential HCCs isn’t new, and it isn’t rare. Dozens of systems on the market can open a medical record and flag coded conditions. That’s the finding part, and it’s largely a solved problem. The proving part is where programs fail. Finding a diagnosis in a chart and proving that the diagnosis meets CMS’s evidentiary standard are two entirely different operations. The first requires pattern recognition. The second requires clinical evidence validation against








