Your concurrent coding program is running smoothly. Charts get reviewed within 48 hours of encounters. Queries go out quickly. Your capture rates are excellent. The numbers look great.
Then a provider group sends a letter to your CEO. They’re threatening to terminate their participation agreement because your concurrent coding program is “harassing” their physicians with excessive queries and creating unsustainable documentation burden.
You didn’t see it coming because you were watching coding metrics, not provider relationship health. Here’s how concurrent coding programs inadvertently destroy provider relationships and how to prevent it.
The Invisible Burden Accumulation
Your concurrent program sends five queries per week to Dr. Martinez. From your perspective, that’s reasonable. It’s spread across different days. Each query only takes 3-5 minutes to answer.
What you don’t see: Dr. Martinez also gets queries from quality improvement programs, utilization review, care management, pharmacy benefits management, and two other health plans you’re not aware of.
Your five queries per week combine with everyone else’s queries to create 20-25 queries per week. That’s 90-120 minutes of unpaid administrative work on top of clinical responsibilities.
Dr. Martinez doesn’t distinguish between your queries and everyone else’s. To her, it’s all the same overwhelming administrative burden. When she complains, your concurrent coding program gets blamed even though you’re only contributing 25% of the total burden.
Most concurrent coding programs track their own query volume but have no visibility into total administrative burden providers face. They optimize their own metrics without realizing they’re the straw breaking the camel’s back.
The Tone Deterioration Problem
Your concurrent queries start professionally. “Dr. Martinez, could you please clarify the following documentation gap…”
Three months in, providers aren’t responding as quickly. Deadlines are added to queries. “Please respond within 48 hours.”
Six months in, reminders are automated. “Second notice: Please respond to outstanding query.”
Nine months in, escalations happen. “Per our contract, timely query response is required.”
Twelve months in, the tone is adversarial. Providers feel policed rather than supported.
Nobody intended for this to happen. It evolved gradually as the concurrent team tried to improve response rates. Each small change seemed reasonable. The cumulative effect is that provider communications have shifted from collaborative to punitive.
Providers who initially engaged cooperatively now respond defensively or not at all.
The Context-Free Query Problem
Your concurrent coder reviews yesterday’s chart. The documentation shows diabetes but doesn’t specify complications. The coder sends a query: “Please specify diabetes complications for proper HCC assignment.”
Dr. Martinez sees that query and thinks: “I spent 45 minutes with this complex patient managing multiple acute issues. This coder reviewed the chart for 10 minutes and is questioning my documentation? They have no idea what was clinically relevant during that visit.”
The query is technically correct. The documentation could be more complete. But it lacks clinical context and empathy for the complexity of the actual patient encounter.
Queries that feel clinically tone-deaf create resentment. Providers start viewing concurrent coders as bureaucrats who don’t understand clinical reality.
The Volume Insensitivity
Your concurrent program has quotas. Coders need to review 40 charts per day. Each chart takes 15 minutes. If 30% of charts need queries, that’s 12 queries per day per coder.
You have five coders. That’s 60 queries daily or 300 per week going to your provider network.
From the coding team’s perspective, this is just meeting productivity targets.
From the provider network’s perspective, this is 300 interruptions per week demanding unpaid work.
When you’re measured on charts reviewed, you optimize for chart volume. When providers are measured on patient care, they optimize for clinical time. These goals conflict.
Concurrent programs that survive long-term recognize this conflict and throttle their own productivity to maintain sustainable provider burden levels. They review fewer charts, but maintain the provider relationships that make concurrent coding possible.
The Specialty Disconnect
Your concurrent program applies the same query standards across all specialties. Endocrinologists get the same diabetes complication queries as primary care physicians.
But endocrinologists document diabetes complications in much greater detail naturally. They don’t need prompting. The queries feel unnecessary and insulting.
Meanwhile, orthopedic surgeons rarely document diabetes complications because they’re focused on surgical issues. The queries feel irrelevant to their specialty.
One-size-fits-all concurrent programs generate high volumes of low-value queries for many specialists. This creates specialty-specific resentment.
The Competing Priority Clash
Your concurrent query asks Dr. Lee to document CHF severity more completely. This is important for risk adjustment.
Dr. Lee is simultaneously being asked by quality programs to improve diabetes A1C testing rates, by utilization review to justify imaging orders, and by care management to complete medication reconciliation forms.
All of these are framed as important. None compensate for the time required. Dr. Lee has to choose which administrative requests to prioritize.
Risk adjustment queries frequently lose because they’re perceived as revenue-focused rather than patient-focused. Providers prioritize quality metrics and care coordination over coding optimization.
Concurrent programs that position queries as administrative revenue work get deprioritized. Concurrent programs that position queries as improving clinical documentation for care coordination get better engagement.
The Attribution Confusion
Dr. Patel receives concurrent queries about her patients. But 40% of those patients aren’t actually her patients. They saw Dr. Patel once for urgent care but their primary care is elsewhere.
Dr. Patel is being asked to complete documentation for patients she’s not managing longitudinally. She doesn’t have the clinical context. She doesn’t feel responsibility for their ongoing risk adjustment coding.
Concurrent programs that don’t filter for meaningful provider-patient relationships generate queries that providers view as misdirected administrative noise.
What Actually Works
Maintaining provider relationships in concurrent coding requires treating provider burden as seriously as coding productivity.
Track total administrative burden providers face from all sources, not just your queries. Monitor query tone over time and reset to collaborative language regularly. Add clinical context to queries showing understanding of encounter complexity. Throttle query volume to sustainable levels even if it means lower productivity. Customize query types and frequency by specialty. Frame queries in terms of care quality, not revenue optimization. Filter queries to only reach providers with meaningful patient relationships.
The concurrent coding programs with the best long-term results aren’t the ones with the highest query volumes. They’re the ones providers still willingly engage with after two years because the program maintained relationship health while improving documentation.
