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Sample Data:
I5020,E1122,J449 Use this!
Category/ICD10 Diagnosis Description HCC V24 RAF Score MA Payment
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Discover the RAF Score Tool to streamline post-prospective chart reviews and enhance clinical document improvement (CDI) recommendations.


The RAF Score integrates demographic, diagnosis, and disease interaction risk scores to offer a holistic patient health status assessment with risk factor, age, gender, and diagnosis codes. The demographic risk score encompasses critical factors such as age, community, medical institution, and age-gender interactions. Meanwhile, the diagnosis risk score is founded upon the Hierarchical Condition Category (HCC) codes extracted from the patient's ICD-10 codes for diagnosis, reflecting chronic conditions.
By meticulously analyzing these factors, it offers an accurate understanding of a patient's health landscape. The importance of the Risk Adjustment Factor Score cannot be overstated as they directly impact budgeting and resource allocation for shared-risk providers and payers.
A low risk score, while potentially indicating a healthier population, can also highlight the significance of accurate and comprehensive documentation. On the flip side, a high risk score signals patients with heightened health risks, necessitating a more intricate level of care and allocation of resources. An HCC RAF score of 1.00 serves as a benchmark for average resource utilization, while an HCC risk score surpassing 1.00 signifies increased resource requirements.

Benefits of RAF


  • With the RAF Score Calculator, the healthcare providers and payers gain a precise tool to allocate resources effectively. In addition to it, the CMS HCC RAF score directly influences the average Medicare Advantage patient rate, ensuring that resource allocation corresponds accurately to a patient's health status.
  • This tool is designed exclusively for medical coders and physicians. Its purpose is to streamline your approach to post-prospective chart reviews and clinical document improvement (CDI) recommendations.
  • It greatly assists medical coders in calculating risk scores with revenue impact, making the analysis process remarkably easy and quick.
  • This innovative tool transforms healthcare from a generalized to a patient-centric, fine-tuned, and results-oriented approach.

How To Use This Tool for RAF Score


There are three primary categories of risk models in this Calculator: CMS-HCC, RxHCC, and ESRD, each featuring distinct models for both continuing and new enrollees. Upon selecting a risk model, you will find a list of corresponding risk factors available for selection. Following this, you can choose the gender and input an age up to 120.
Subsequently, you can enter up to 20 diagnosis codes either by manual entry or by copying and pasting them into the provided text box, separating them with commas.
For record removal, the delete button is available at the end of each row. Upon inputting all necessary data, click the submit button to generate the Revenue Impact Report.
Our RAF Score Calculator performs distinct calculations for RISK scores and Medicare Advantage Payment across demographics, diagnoses, and disease interactions. At the bottom of the Revenue Impact Report, you can find the button to download the report in PDF format generated by our RAF Score Calculator.
Suggested Pages
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A Comprehensive Guide on HCC Coding Reviews

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Understanding the CMS HCC Risk Adjustment Model and its Significance

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The Role of RAF Score Calculator in Achieving Sustainable Success in Risk Adjustment

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Understanding HCC Risk Adjustment Coding (RA) in Healthcare Industry

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