The Top Reasons RAF Scores are Low, According to

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The Top Reasons RAF Scores are Low, According to

August 26
09:40 2020
The Top Reasons RAF Scores are Low, According to

The RAF score, also known as the risk adjustment factor score, is used by insurance companies and CMS to represent a person’s health status. Typically, a person’s RAF score is used to estimate how much it will cost to provide care for a patient. The RAF score someone receives is based on their health conditions that are mapped to a Hierarchical Condition Category (HCC) and their demographics. Ensuring the RAF scores are accurate is essential to virtually all healthcare organizations because they will ensure there is enough funding to provide a high level of patient care required.

However, getting accurate RAF scores isn’t that easy. Even if healthcare organizations put their best clinical efforts forward, they may notice their RAF scores are very low or that the scores don’t reflect the actual patient population. According to, ensuring that an RAF score is accurate isn’t easy, but it is essential to ensure the right compensation amount is provided for the care given. While there are some helpful resources out there to use, it’s also a good idea to learn some of the most common reasons an RAF score may be inaccurate, which are found here.

The Medical Facility Isn’t Using HCC Coders 

Properly documenting and capturing HCC codes for every patient is essential to achieve accurate patient risk scores and to ensure the proper amount of reimbursement is provided. It has been estimated that the average practice or organization may be able to increase total reimbursement rates by up to 20 percent by using coding reviews.

There are some medical organizations that are still mainly reliant on physicians when it comes to ensuring that the accurate HCC codes are captured. However, physicians are already challenged to offer the best quality of care possible, which includes focusing on patient care and working to provide patients with quality treatment. With the limited time that doctors have to capture this information and all the intricacies that are involved, they are not always in the best position to provide the complete diagnosis codes needed for a patient.

A coder, like Foresee Medical, specializes in turning the information in a physician’s documents into the proper coding. This makes them an invaluable resource for any organization.

Only Using Retrospective HCC Coding Reviews 

This is something that takes place once the initial claim is submitted to the payer. This is better than no coding review, but it is a cumbersome, expensive, and manual process that puts a huge burden on all healthcare organizations. By using a concurrent and prospective review process, it is possible to eliminate the need for the retrospective review.

Don’t underestimate the benefits offered by taking the right steps and getting the codes right the first time. Along with understanding the essentials, it is also possible to see health care workers show their glam side on TikTok, which reveals that even medical workers like to have fun from time to time. While this is true, the importance of proper coding can’t be ignored.

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