Raf Score Calculator

RAF Score Calculator (HCC Risk Adjustment)

Male, 65-69 Male, 70-74 Male, 75-79 Male, 80-84 Male, 85-89 Female, 65-69 Female, 70-74 Female, 75-79 Female, 80-84 Female, 85-89

Non-Dual (No Medicaid) Full Dual (Medicaid + Medicare) Partial Dual

Common HCC Categories (Select all that apply):

Manual entry for disease-disease interaction coefficients (e.g., CHF + COPD interaction).

Estimated RAF Score

0.000

function calculateRafScore() { var baseDemo = parseFloat(document.getElementById('demoCategory').value); var medicaid = parseFloat(document.getElementById('medicaidStatus').value); var interaction = parseFloat(document.getElementById('interactionAdjustment').value) || 0; var hccs = [ 'hcc19', 'hcc18', 'hcc108', 'hcc85', 'hcc111', 'hcc136', 'hcc96', 'hcc22' ]; var hccTotal = 0; for (var i = 0; i < hccs.length; i++) { var element = document.getElementById(hccs[i]); if (element.checked) { hccTotal += parseFloat(element.value); } } var totalScore = baseDemo + medicaid + hccTotal + interaction; document.getElementById('finalScore').innerHTML = totalScore.toFixed(3); var description = ""; if (totalScore = 1.0 && totalScore < 2.0) { description = "Moderate risk patient profile."; } else { description = "High risk/Complex patient profile."; } document.getElementById('riskDescription').innerHTML = description; document.getElementById('rafResultBox').style.display = 'block'; }

Understanding the RAF (Risk Adjustment Factor) Score

A Risk Adjustment Factor (RAF) score is a metric used by CMS (Centers for Medicare & Medicaid Services) to estimate the predicted healthcare costs for a patient. In the Medicare Advantage model, the RAF score determines the payment amount provided to health plans to cover a specific member's care.

How the Calculation Works

The total RAF score is the sum of several distinct components:

• Demographic Variables: These are base scores determined by a patient's age, sex, and original reason for entitlement (e.g., age 65-69 vs. age 85+).
• HCC Codes: Hierarchical Condition Categories (HCCs) are mapped from ICD-10 diagnosis codes. Each category has a "weight" representing the cost of treating that condition.
• Medicaid/Dual Status: Patients who are "Dual Eligible" (qualified for both Medicare and Medicaid) often receive a higher risk weighting due to socioeconomic complexity.
• Interaction Factors: When a patient has multiple specific chronic conditions (like CHF and COPD simultaneously), the model may add an "interaction bonus" to account for the increased complexity of managing both.

RAF Score Example Scenario

Consider a 72-year-old male with Medicare only (Non-Dual):

• Demographic Base: 0.385
• Diabetes w/ complications: + 0.318
• Vascular Disease: + 0.298
• Estimated Final RAF Score: 1.001

In this example, the patient's health profile is roughly equivalent to the average Medicare beneficiary (which is standardized at 1.0).

Why RAF Scores Matter in Healthcare

Accurate RAF scoring is critical for value-based care. If a patient's conditions are not documented correctly, the RAF score will be lower than reality, leading to underfunding for that patient's actual care needs. This calculator helps providers and coders estimate the impact of chronic condition documentation on the overall risk profile of their patient panel.