Risk Adjustment · HCC recapture

Recapture from 74.1% to 82.3%

The 8.2-point difference is HCC value that would have stayed open. For one Medicare Advantage group it came to $14.8M a year, closed at routine visits.

See your recapture rate Break it down by center

Known HCC value, per year$180.5M closed + open

+$14.8M netted

$133.8M74.1% before

$32.0Mstill open

74.1%82.3%100%

Closed at 74.1%Netted to reach 82.3%Still open

Open and closed codes

Every HCC on the panel is in one of three states

Suspected

The data points to it

A vendor list, hospital feed, coder or the EHR suggests a condition nobody has confirmed. Closing one is net-new value.

Open

Known, not documented this year

The patient has the condition on file, but it has not been assessed and coded at a visit this year. Until it is recaptured, it pays nothing.

Closed

Captured

Assessed and documented at a visit this year. Antidote then checks each closed HCC against a claim, so a closure with no claim behind it gets flagged.

Recapture rate= closed HCC dollars ÷ (closed + open HCC dollars)Suspects are net-new, counted separately below

How offices capture

An open code closes at the visit, not in a year-end chart chase

1 · Morning

Daily Huddle

The office sees today's schedule with each patient's open and suspected codes, gaps and tests due.

2 · In the visit

Patient sidecar

The provider reviews each code next to the chart with its evidence, then marks it closed or rules it out.

3 · After

Claim check

Closed HCCs are matched to claims. Anything closed without a claim shows up as dollars at risk.

4 · Every week

Center standings

Each center gets a Huddle Score and a tier: on track, watch or needs attention. Leaders see who to help.

What it does to a large MSO

8.2 points of recapture netted $14.8M a year

netted per year: $14.8M
per member per month: $59
per year for each point: $1.8M
left open: $46.8M → $32.0M

One group, last full period (Jan–Jun 2026): 20,991 active Medicare Advantage members across 37 centers, $180.5M a year of closed plus open HCC value (CMS V28). HCC value, not realized revenue. Client identity withheld.

Revenue recapture by center

Where the $14.8M came from

Closed before (74.1%)Netted (+8.2 pts)Still open

Center	Members	Known HCC value	Closed before	Netted	Still open
Center 1	1,720		$2.65M	+$0.29M	$0.63M
Center 2	1,262		$5.98M	+$0.66M	$1.43M
Center 3	1,208		$8.41M	+$0.93M	$2.01M
Center 4	1,189		$9.00M	+$1.00M	$2.15M
Center 5	1,048		$3.36M	+$0.37M	$0.80M
Center 6	1,018		$5.51M	+$0.61M	$1.32M
Center 7	960		$3.98M	+$0.44M	$0.95M
Center 8	762		$6.68M	+$0.74M	$1.59M
Center 9	755		$3.56M	+$0.39M	$0.85M
Center 10	719		$6.02M	+$0.67M	$1.44M
Center 11	607		$2.61M	+$0.29M	$0.62M
Center 12	589		$4.12M	+$0.46M	$0.98M
25 more	9,154	$97.03M known	$71.90M	+$7.96M	$17.17M
All 37 centers	20,991	$180.5M known	$133.8M	+$14.8M	$32.0M

Each bar is a center's closed plus open HCC value, drawn to scale against the largest center and split at the group rates: 74.1% closed before, 8.2 points netted, 17.7% still open. The 12 largest centers are shown, names withheld. In the product, each row opens the patients and HCCs behind it.

On top of recapture: net-new suspects

We found $213 PMPM hiding in the suspect lists

Recapture closes what is already known. Suspects are conditions nobody has documented yet. Antidote removes the ones already on the chart and prices the rest.

per year: $69.7M
patients to reach: 6,687

1 · Take in

Suspects from vendor lists, hospital feeds, coders and the EHR

30,087

2 · Filter

Already closed, open or ruled out on the same HCC

−11,964

3 · Price

Net-new, priced with CMS V28, hierarchies applied

18,123

Top net-new conditions

patients · 111 HCCs total

Diabetes, no complications
1,640
CKD, stage 3
1,406
Diabetes with complications
1,211
COPD and chronic lung
846
Heart failure
833
Morbid obesity
680
Heart arrhythmias
636
CKD, stage 3B
618

Suspect review case study, September 2026: one Medicare Advantage group, 27,225 lives. 40% of suspects were already on the chart. Opportunity at full documentation, not realized revenue. Client identity withheld.

Same worklist, more than HCCs

Quality, discharges and refills ride along

HEDIS gaps

Open measures show on the huddle and in the sidecar, so the gap is closed at the same visit as the code.

Annual wellness visit
Breast cancer screening
Blood pressure control
A1C
Kidney health
Med reconciliation

Hospital discharge workflow

Admissions and discharges arrive from hospital feeds with facility, diagnosis and disposition.

Discharge lands on the office worklist
Follow-up visit gets a due-by date
Office schedules it and the appointment is verified
Readmissions are flagged

Medication adherence

Each refill coming due becomes a task the office works before its impactable window closes.

Needs outreach
Pharmacy or patient contacted
Refill requested
Pickup confirmed, or escalated

What would better recapture net for your group?

Send your roster, condition and suspect files. We will send back the breakdown by center.

See your recapture rate

Dollar figures are HCC value at full documentation, not realized revenue.

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