Raf Score Cheat Sheet

Chronic Kidney Disease Severe Stage 4 Artificial Openings for Feeding or Elimination.

Raf score cheat sheet. A Higher Acuity Score means sicker patients are being cared for with lower costs. 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. 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.

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. The codes are additive meaning patients can meet multiple categories and. 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.

RAF is a relative measure used to predict the expenditure level of the patient. 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. Risk Score calculation Risk Score Eligibility Dx from Supp.

Not all claims are valid for risk adjustment purposes. Member a RAF Risk Adjustment Factor score. Confidential and Proprietary Information 5.

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. Medicare Advantage and exchange plans are paid based on patients RAF scores. 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.

There are no negative RAFs. The RAF for the average patient is 10. Risk adjusment models and parameters for Medicare Advantange rates and Prescription Drug rates.