Healthy patients have a below-average RAF less than 10 while sicker patients have an above-average RAF greater than 10. RAF HCC DX 0 NA N181 Stage 1 CKD 0 NA N182 Stage 2 CKD 0 NA N183 Stage 3 CKD 0288 137 N184 Stage 4 CKD 0288 136 N185 Stage 5 CKD 0288 136 N186 Stage 6 CKD RAF HCC DX 0456 134 Z992 Dependence on renal dialysis 0456 134 Z9115 Patients noncompliance with renal dialysis RAF HCC DX 0105 19 E119 Type 2 diabetes mellitus without complications.
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Risk Score calculation Risk Score Eligibility Dx from Supp.
Raf score cheat sheet. RAF Score Organization average RAF score similar to case mix 1 a patient expected to use average resources 1 a patient expected to use fewer resources 1 a patient expected to utilize greater resources Risk Adjustment Factor RAF spread. 121 rows Use this cheat sheet to identify diagnosis codes that are weighted for risk adjustment. A Higher Acuity Score means sicker patients are being cared for with lower costs.
An organizations risk-adjusted measure score is the score that would be obtained for a given organization based on the results of the regression model if the average of the predictor variables for that organization were equal to the national average across all. G5790 Mononeuropathy of left lower limb NA NO RAF g609 Hereditary and Idiopathic nueropathy NA NO RAF I96 I700 2018 2018 106 108 Gangrene not elsewhere classified Atherosclerosis of Aorta Y Y 1461 0298 g619 2018 75 Inflammatory polyneuropathy unspecified N 0457 2018 Demographic Risk Factor 0379 2018 HCC Risk Factor 2236 2018 Total Risk Factor 2615. Age and sex Medicaid status and Medicare eligibility due to a disability Chronic conditions and disease interactions 10.
Chronic Kidney Disease Stage 5. Medicare Advantage and exchange plans are paid based on patients RAF scores. 118 - 24888 Risk Adjustment Scores.
There are no negative RAFs. Data Source Dx from Claims Hospital Claims Provider Claims In-Home Assessments Rx Claims Medical Record Review Other Supplemental Data Files Note. In theory the higher the RAF score the more medically complex the Member will be.
The average CMS FFS patient has the score of 100 RAF is a numeric value assigned by CMS to identify the health status of a patient RAF scores are made up of the following criteria for each member. Risk adjusment models and parameters for Medicare Advantange rates and Prescription Drug rates. The RAF for the average patient is 10.
The codes are additive meaning patients can meet multiple categories and. RAFPatientAcuityScore If Claims Paid are the same for 2 populations using a Risk Score calculates an effective cost for each group of patients A Lower Acuity Score results in a higher cost for patient care. Confidential and Proprietary Information 5.
RAF Value Validated by Current Documentation Improved Documentation HCC 58 F3341 Major depressive disorder recurrent in partial remission 0395 No Yes HCC 12 C50919 Malignant neoplasm of unspecified site of unspecified female breast 0146 Yes Yes HCC 22 E662 Obesity hypoventilation syndrome OHS 0273 No Yes Demographics 54-year-old. 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. RAF is a relative measure used to predict the expenditure level of the patient.
Higher risk scores or RAF medical abbreviation RAF score represent patients with a greater than average disease burden. Chronic Kidney Disease Severe Stage 4 Artificial Openings for Feeding or Elimination. A score of 100 is average with the decimal places representing percentages above or below average.
RAF Risk Adjustment Factor - A coefficient that adds together reported ICD-10 codes demographics to create the risk profile of a Medicare member. There are approximately 8800 ICD-10 codes that map to HCC categories. The goal of risk adjustment is to enable more accurate comparisons across networks that treat beneficiaries of varying clinical complexity.
Not all claims are valid for risk adjustment purposes. RAF HCC DX 0383 55 F1020 Alcohol dependence uncomplicated 0383 55 F1021 Alcohol dependence in remission 0383 55 F1220 Cannabis dependence uncomplicated 0383 55 F1120 Opioid dependence uncomplicated RAF HCC DX 0588 189 Z89411 Acquired absence of right great toe 0588 189 Z89412 Acquired absence of left great toe. RISK ADJUSTMENT FACTORS RAF CMS uses risk adjustment to account for differences in beneficiary-level risk factors that can affect quality outcomes or medical costs regardless of the care provided.
Member a RAF Risk Adjustment Factor score.
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Raf Score Cheat Sheet. There are any Raf Score Cheat Sheet in here.
