How is a RAF score calculated?
The risk adjustment factor (RAF) score is the risk score assigned to each patient in a risk adjustment payment model. Risk Adjustment Models account for multiple factors to calculate a RAF score which is the combination of both the demographic risk score and the disease risk score.
What is a high RAF score?
Higher risk scores or RAF medical abbreviation “RAF score”, represent patients with a greater than average disease burden. Lower risk scores represent a healthier population view, but may also falsely indicate a healthy population when there is poor chart documentation or incomplete Medicare risk adjustment coding.
What is a normal RAF score?
1.00
A score of 1.00 is average, with the decimal places representing percentages above or below average. For example, if a plan’s average patient RAF score is 1.10, it will receive 10 percent more from Medicare.
How is Medicare risk score calculated?
The purpose of the Medicare risk scores is to estimate a relative cost factor. (i.e., it is a payment risk score). CMS calculates individual beneficiary-level risk scores by adding the relative factors associated with each beneficiary’s demographic and disease factors.
How can I improve my RAF score?
Learn How Top-Performing Organizations Improve RAF Score Accuracy—Free eBook
- To increase RAF score accuracy, start with HCC coding:
- Leverage your current EMR/RCM workflows:
- Educate providers on HCC coding’s impact on reimbursement:
- Prepare for each patient visit:
- Employ—and value—HCC coding experts:
What is the difference between HCC and RAF?
HCC codes are additive, and some have multipliers. Population complexity/severity affects payment in many Medicare contracts. RAF is used for benchmarking for quality and safety. RAF enables identification and stratification for patient management.
What is a Medicare risk Adjustment Factor?
Risk adjustment is a statistical method that seeks to predict a person’s likely use and costs of health care services. It’s used in Medicare Advantage to adjust the capitated payments the federal government makes to cover expected medical costs of enrollees.
What is risk adjustment in Medicare?
Risk adjustment is used to adjust payments to Medicare Advantage Organizations (MAOs), Program of All Inclusive Care for the Elderly (PACE), certain demonstrations and Part D sponsors for the expected healthcare costs of their enrollees based on disease factors and demographic characteristics.
What is an HCC RAF score?
RAF Score = Patient Demographics (Age, Gender, etc.) + Sum of HCC Codes (Factor) The risk adjustment factor score identifies a patient’s health status. Each patient has a RAF score, which includes demographic elements like age and gender that can impact the final number.
What is RAF risk adjustment factor?
A RAF score, or risk adjustment factor score, is a medical risk adjustment model used by the Centers for Medicare & Medicaid Services (CMS) and insurance companies to represent a patient’s health status. RAF scores are used to predict the cost for a healthcare organization to care for a patient.
What is risk adjustment score?
What is the difference between RAF and HCC?
What is Medicare risk adjustment score?
What is HCC risk score?
The CMS-HCC risk score for a beneficiary is the sum of the score or weight attributed to each of the demographic factors and HCCs within the model. The CMS-HCC model is normalized to 1.0. Beneficiaries would be considered relatively healthy, and therefore less costly, with a risk score less than 1.0.