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how to find controllable adjustments in EPIC?

You find controllable adjustments in Epic by working within the “Find and Fix” part of the risk‑adjustment workflow rather than hunting for a single screen called “controllable adjustments.” In most Epic implementations, these are the diagnosis gap or RAF/HCC opportunities that a clinician or coder can actively address in the chart. Below is a friendly‑professional, slightly storytelling walkthrough you can adapt to your local build.

Quick Scoop

Think of Epic as showing three kinds of risk‑adjustment issues:

  • Things you can control right now (missing or outdated diagnoses you can document).
  • Things partly controllable (needs documentation plus an external process, like prior records or payer confirmation).
  • Things not really controllable (payer logic, non‑editable historical data).

Your goal is to filter for the first group and focus your time there.

1. Where “controllable adjustments” usually live

Most organizations don’t label the section “controllable adjustments”; instead they expose it as:

  • Risk‑adjustment or HCC workqueues.
  • RAF/HCC “gaps” in the patient chart.
  • Quality / financial dashboards that show “actionable” vs “non‑actionable” items.

Common places to look:

  • In Hyperspace:
    • A Risk Adjustment or Population Health tab on the main toolbar.
    • A specific workqueue with a name like “Risk Adj – Provider” or “HCC Gaps – Actionable.”
  • In the patient chart:
    • A navigator section named Risk Adjustment , HCC Review , RAF Review , or similar.
    • Side panels that show “Diagnoses due to be recaptured” for the current calendar year.

On many sites, opening the risk‑adjustment navigator or workqueue automatically filters to “open” or “needs attention” items, which line up with your controllable adjustments.

2. Using filters to isolate controllable items

Most Epic lists and workqueues share the same logic:

You start broad, then narrow down to what you can actually change this visit.

Once you’re in the relevant list (e.g., your risk‑adjustment workqueue or panel), use:

  • Status / disposition filters:
    • Include only items with statuses like “Open,” “Needs review,” “Gap present,” or “Action required.”
    • Exclude items marked “Resolved,” “Closed,” “Rejected,” “Non‑actionable,” or “Historical only.”
  • Date‑based filters:
    • Limit to current performance year (e.g., 2026 encounters or coverage year).
    • Optional: focus on upcoming appointments or “seen in last 90 days” to keep the list practical.
  • Responsibility filters:
    • “Assigned to me” or “Assigned to my department/service.”
    • Some builds have “Provider‑controllable only” or “Clinical action possible.”

On the chart level, the risk‑adjustment navigator typically highlights:

  • Chronic diagnoses that should be recaptured this year.
  • Missing documentation supporting existing claims.
  • Potential HCCs that were coded in prior years but not yet in the current year.

Those are your most straightforward controllable adjustments.

3. Mini step‑by‑step: as a clinician

Here’s a simple visit‑flow story you can follow.

  1. Open the chart and navigator
    • Go to the patient’s chart.
    • Launch the Risk Adjustment / HCC / RAF navigator section used at your site.
  2. Review the “gaps” list
    • Look for a panel that shows:
      • Prior‑year HCCs not yet coded this year.
      • Suspected but undocumented conditions.
      • High‑impact chronic diseases (CHF, COPD, diabetes with complications, CKD, etc.).
  3. Decide what is truly controllable
    • Controllable now:
      • You have clinical evidence in the chart or from today’s encounter.
      • You can document the condition and link it to today’s visit.
    • Not controllable today:
      • No evidence, no time, or needs outside records, imaging, or consults.
    • Mark or disposition items accordingly (e.g., “addressed,” “not applicable,” “needs records”).
  4. Document and code
    • Add precise diagnoses to the note/problem list.
    • Ensure they are associated with the encounter so coding/RAF capture can occur.
    • Use any local SmartText or SmartSet that pulls in common risk‑adjustment diagnoses with appropriate prompts.
  5. Close the loop
    • Before signing the note, recheck the risk‑adjustment panel.
    • Confirm that any gaps you addressed are now marked as resolved or “recaptured.”

Over time, Epic’s dashboards and workqueues will show improved RAF/HCC capture driven by these controllable actions.

4. Mini step‑by‑step: as a coder / analyst

If you’re not the bedside clinician, you’ll usually work in queues, reports, or registries.

  1. Open your risk‑adjustment workqueue
    • Look for queues like:
      • “Risk Adj – Coding Review”
      • “HCC Suspect – Actionable”
      • “RAF – Provider Follow‑up”
    • These often already segment items into “clinical action needed” vs “administrative only.”
  2. Use advanced filters (workqueue or report)
    • Filters for “Provider action required” or “Clinical documentation missing.”
    • Exclude “claim denied due to payer rules” or “closed – payer only issues.”
    • Focus on patients with upcoming visits so clinicians can realistically address the gap.
  3. Mark controllable vs non‑controllable
    • Controllable:
      • Missing diagnosis documentation.
      • Ambiguous chronic conditions needing clarity.
    • Non‑controllable:
      • Pure timing or payer logic (e.g., risk windows, reinsurance, plan transition).
    • Many teams use a discrete status or flag so provider lists only show the first group.
  4. Communicate with clinicians
    • Use non‑intrusive messaging:
      • Note‑level messages, in‑basket folders, or navigator prompts.
    • Keep the request tight: “Please confirm and document CHF status; last note suggests chronic condition but not coded this year.”

This way, your “controllable adjustments” become a pipeline of precise asks rather than a vague list.

5. Different viewpoints: clinical vs administrative

It helps to think about controllable adjustments from a few angles:

  • Clinician viewpoint:
    • “Can I ethically and accurately document this condition today?”
    • “Is this improving patient care and clarity, not just numbers?”
  • Coding / revenue viewpoint:
    • “Does this documentation support accurate HCC/RAF and reduce lost revenue?”
    • “Are we focusing on high‑impact chronic conditions rather than low‑yield edge cases?”
  • Compliance viewpoint:
    • “Are we making risk score changes only where supported by evidence?”
    • “Do prompts guide, but not force, coding decisions?”

Healthy Epic builds deliberately emphasize documentation that is medically appropriate and well‑supported. Controllable adjustments are the intersection of clinical truth and coding opportunity.

6. If your Epic doesn’t show a “controllable” label

Not every organization turns on the same features. If you don’t see an obvious “controllable adjustments” indicator:

  • Ask local support:
    • Your Epic training team, analyst, or super‑user may know the exact name of:
      • Risk‑adjustment workqueues.
      • HCC navigator sections.
      • RAF dashboards.
  • Check provider personalization options:
    • Many implementations let you add:
      • A Risk Adjustment or HCC sidebar to your main chart view.
      • Custom reports or lists that show “my high‑risk patients with open gaps.”
  • Start simple:
    • Even a basic patient list + column filters can act as a home‑grown controllable‑adjustments view:
      • Column for “HCC gap present.”
      • Column for “Upcoming appointment.”
      • Column for “Assigned provider.”

7. Today’s context & trends

In the mid‑2020s, there’s been a clear trend across health systems:

  • More use of embedded risk‑adjustment tools inside Epic rather than external RAF trackers.
  • Heavy emphasis on:
    • Ethical documentation.
    • Transparent visibility of gaps.
    • Giving clinicians lightweight, in‑workflow prompts rather than separate applications.

So “finding controllable adjustments” increasingly means:

  • Opening a standardized risk‑adjustment navigator.
  • Using built‑in filters and statuses.
  • Focusing on items flagged as clinically actionable in this calendar year.

TL;DR

  • You won’t usually see a button literally called “controllable adjustments” in Epic.
  • Instead, open your Risk Adjustment / HCC / RAF navigator or workqueue.
  • Filter to open, provider‑actionable, current‑year items and treat those as your controllable adjustments.
  • Clinicians close gaps through clean documentation; coders and analysts curate and flag those gaps into practical lists.
  • If the feature isn’t obvious, check with your local Epic team for the specific navigator, workqueue, or dashboard they use for RAF/HCC gap management.

Bottom note: Information gathered from public forums or data available on the internet and portrayed here.