RAF SCORE STUDY

RAF CASE STUDY

Risk Adjustment 101: Case Study

 

Scenario 1- Represents what would actually be coded and reported to the plan by many providers (MD,DO,NP,PA).

ConditionICD 9/Custom CodeCMS Risk ScoreDemographic ScoreTotal RAF ScoreTotal Payment $800 (illustrative purposes) x Raf Score
Diabetes Mellitus 250.OO 0.162 0.44 0.602 $481.60
UTI 599.0 0.0

 

Scenario 2- Represents what can be coded and reported to the plan by the providers if they have the appropriate tools and education of proper utilizing their assessments and coding it correctly.

By using our Modern Medics, we can assure you that every provider will be trained to fully optimize the appropriate diagnosis that are risk adjusted.

ConditionICD 9/Custom CodeCMS Risk ScoreDemographic ScoreTotal RAF ScoreTotal Payment $800 (illustrative purposes) x Raf Score
Diabetes Mellitus w/ Renal manifestations 250.40 0.508 0.44 3.094 $2,475.20
UTI 599.0 0.0
CKD Stage 3 585.3 0.368
Mild Degree Malnutrition 263.10 0.856
Old MI 412 0.244
BKA V49.75 0.678
Source: Anthem Blue Cross
Payment = Plan's base payment x total RAF score