BC Advantage - 2024 Issue 6

Understanding the Intricacies of RAF Coding: A Comprehensive Guide

In the complex ecosystem of healthcare, Risk Adjustment Factor (RAF) coding stands as a crucial methodology, particularly within the Medicare Advantage (Part C) framework. This article offers a deep-dive exploration into RAF coding, examining its historical origins, the intricacies of the risk adjustment model it employs, the application of the RAF score, and the profound influence of chronic versus acute conditions on these scores and reimbursement rates.   The Genesis of RAF Coding   The advent of RAF coding can be traced back to the late 1990s, following the Balanced Budget Act of 1997. This legislative move marked a...

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