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What is a Risk Adjustment Factor (RAF)?

What is a Risk Adjustment Factor (RAF)?

The Risk Adjustment Factor (RAF) score is a numerical value associated with financial reimbursement. It’s usually associated with the Center for Medicaid and Medicare Services (CMS) or other government agencies, particularly with Medicare Advantage.

What is the Risk Adjustment Factor (RAF)? 

The RAF score takes into account the disease risk score and demographic risk data to calculate fair payment of benefits for healthcare services. While that sounds simple enough, the method of RAF score calculation means that practices must accurately report the patient's diagnosis, assessment, and plan to improve their RAF score while performing medical billing.

How Do You Calculate Risk Adjustment? 

To calculate the RAF score, you look at your patient’s diagnosis and other factors. Here are just a few of the risk factors you may consider: 

  • Age

  • Disability

  • Gender

  • Geographic region

  • Medicaid status

  • Medical history

  • Original Medicare entitlement

To understand the factors that go into calculating the RAF score, consider the use of appropriate HCC ICD10 codes as part of your billing process. TempDev works practices to better understand and streamline the medical billing process as part of revenue cycle management. 

What Are the Benefits of Risk Adjustment Factor (RAF)? 

Risk Adjustment Factor (RAF) scores offer a snapshot view of patient health for your practice. The goal of the RAF score is to capture the medical codes associated with your patients accurately so you can gauge the treatment needs of your patient community. It can also offer a range of essential benefits for a practice and patient. 

  • More accurate reporting on the severity of a patient's chronic conditions

  • Deliver more effective treatment plans to patients

  • A streamlined medical billing process

With the RAF score, the focus is on the patient’s health factors to better assess ongoing treatment requirements. It’s a gauge that allows a physician to determine with relative certainty what the stability factors will be for a patient. As EHR records are integrated and streamlined, groups may want to invest in Coders to help with HCC coding and improve their RAF scores.

How TempDev Can Help To Improve Risk Adjustment Factor Scores

TempDev’s team of experienced consultants, developers, and trainers are here to support enhanced accessibility, as well as customized features and templates. This enables you and your patients to have more control over data with improved transparency. 

As part of our streamlining process, we help you implement the Patient Portal, API, and other tools to better support safety, patient engagement, and security. From dashboards to automation and workflow redesign, TempDev offers the comprehensive resources and tools you need to improve your RAF scores.

Contact us here or by calling us at 888.TEMP.DEV to ensure compliance with HCC coding and improve Risk Adjustment Factor Scores.


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