You’re running an RFP to select risk adjustment vendors. You’ve assembled a cross-functional team. You’ve created a detailed requirements document. You’ve identified evaluation criteria. You’re doing everything by the book.
And you’re about to make the same mistakes that lead most organizations to select vendors who look great on paper but fail in practice.
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Mistake #1: Scoring Features Instead of Workflows
Most RFPs for risk adjustment vendors include a features checklist. Does the platform have AI-powered coding suggestions? Check. Can it integrate with our EHR? Check. Does it support concurrent and retrospective workflows? Check.
Every vendor checks every box. They all claim to have every feature. The RFP scoring comes down to minor differences in how they describe essentially the same capabilities.
This tells you nothing useful. The question isn’t whether vendors have features. It’s whether their platform supports how your team actually works.
Instead of asking “do you have feature X,” show vendors your actual workflow. “Here’s how our team handles charts that require provider queries. Here’s how we manage QA review. Here’s how we track productivity. Show us how your platform would handle our specific process.”
Watch what happens. Some vendors demo how their platform naturally supports your workflow. Others describe workarounds and customizations. That tells you which platform actually fits your needs versus which platform requires you to change everything to match their assumptions.
Mistake #2: Believing the Accuracy Claims
Every response to risk adjustment vendor RFPs claims 95%+ accuracy or 98%+ accuracy. These numbers are meaningless because vendors define accuracy differently.
One vendor measures accuracy by whether coders assigned the codes the AI suggested. Another measures accuracy by whether codes survived internal QA. Another measures accuracy by whether a sample of charts passed external audit. These aren’t comparable metrics.
Stop asking vendors to self-report accuracy. Instead, require vendors to code 20 of your actual charts during evaluation. Not demo charts. Your charts, with all their messy reality.
Then have your best coder independently code the same 20 charts. Compare results. Where do they differ? How does the vendor handle ambiguous documentation? Do they code conservatively or aggressively?
This tells you more than any claimed accuracy percentage. You see exactly how the vendor codes your actual documentation in your actual clinical environment.
Mistake #3: Treating References as Validation
Your RFP requires vendor references. You call them. They say nice things about the vendor. You check the box and move on.
Of course vendor-provided references say nice things. They’re carefully selected advocates. The vendor isn’t giving you contact information for unhappy customers.
Better approach: ask vendors for a list of all customers in your state or region. Not just references. All customers. Then use your industry network to find someone who actually works with the vendor but wasn’t on the official reference list.
“Hey, I see you’re using Vendor X for risk adjustment. We’re evaluating them. Can I ask you a few questions about your experience?”
That conversation tells you things the official reference won’t. The official reference emphasizes what works well. The unofficial conversation reveals what doesn’t work well and whether those problems would matter to your organization.
Mistake #4: Ignoring Implementation Complexity
Most RFPs evaluate vendors based on their platform capabilities. They don’t adequately evaluate implementation complexity. Implementation is where most vendor relationships fail.
Ask vendors: “Walk me through your implementation process. Who from your team will be involved? What do you need from our team? What are the most common implementation challenges? How long did your last three implementations actually take versus the planned timeline?”
Good vendors are honest about implementation complexity. They admit that integrations take longer than expected. They acknowledge that data migration is hard. They discuss common stumbling blocks.
Bad vendors promise smooth implementations and blame customers when things go wrong. During RFP evaluation, every vendor promises smooth implementations. You can’t tell them apart yet.
So ask for detailed implementation plans. Not generic templates. Actual project plans showing week-by-week milestones, resource requirements, and dependencies. Vendors who’ve done this before can produce detailed plans quickly. Vendors who are newer or less organized can’t.
Mistake #5: Optimizing for Price
Many RFPs weight price heavily in scoring. The vendor who bids lowest gets significant points. This makes sense for commodity purchases. Risk adjustment vendors aren’t commodities.
A vendor who bids $100,000 less but delivers 20% lower productivity creates negative value. A vendor who bids $150,000 more but prevents a RADV audit disaster creates enormous value.
Price matters, but not as a standalone criterion. Price only makes sense in the context of value delivered. Instead of scoring vendors on absolute price, score them on value for price.
Vendor A costs $300,000 and promises 2,000 incremental HCCs captured. That’s $150 per HCC. Vendor B costs $400,000 and promises 3,500 incremental HCCs captured. That’s $114 per HCC. Vendor B costs more but delivers better value.
This requires vendors to commit to measurable outcomes, not just describe capabilities. Most RFPs don’t require outcome commitments. They should.
Mistake #6: Evaluating Presentations Instead of Reality
The typical RFP process includes vendor presentations. Each vendor gets 90 minutes to present their solution. The slickest presentation wins.
Presentation quality tells you nothing about operational execution. Great presenting doesn’t predict great coding, great support, or great results.
Skip the presentations. Instead, require working sessions. Give each vendor access to a test environment with sample data. Ask them to accomplish specific tasks. “Configure a workflow for concurrent coding. Build a report showing coder productivity by provider. Set up the integration with our claims system.”
Watch how they work. Do they know their platform intimately or are they fumbling through menus? Do they ask smart questions about your requirements? Do they build what you asked for or something close?
Technical competence is easier to fake in PowerPoint than in working sessions. Make vendors prove they can actually do the work, not just describe it.
Mistake #7: Letting Procurement Own the Decision
Many organizations let procurement teams run the entire RFP process. Procurement is great at process management, contract negotiation, and ensuring compliance. Procurement doesn’t understand risk adjustment operations.
The people who’ll use the platform daily should drive the evaluation. Coders, coding supervisors, and risk adjustment leadership should be the primary evaluators. Procurement should support them, not lead them.
When procurement leads, you optimize for process compliance and price. When operations leads, you optimize for fitness to actual needs. One produces a defensible decision. The other produces a successful implementation.
Your RFP process determines your vendor selection. Your vendor selection determines your risk adjustment performance for the next 3-5 years. Run the RFP right or live with the consequences of running it wrong.
