Transcription of RISK ADJUSTMENT 2018 AND RAF SCORES 101 - tmgipa.com
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RISK ADJUSTMENT 2018 AND RAF SCORES 101 - tmgipa.com
RISK ADJUSTMENT 2018. AND. RAF SCORES 101. Robert Resnik MD MBA. Terminology HCC- Hierarchical Condition Categories . Chronic conditions used to create a risk ADJUSTMENT methodology (PART A,B,C). RX HCC Some HCC codes adjust risk due to prescription burden of disease (Part D). RAF Risk ADJUSTMENT Factor Demographic RAF for Medicare Enrollees Disease Hierarchies Some HCCs will override others so that if a patient has more than one HCC within a category .. Diabetes HCCs Diabetes with Acute Complications-HCC17. Diabetes with Chronic Complications-HCC18. Diabetes without Complications-HCC19. Then drop the HCC If the Disease Group is Listed in this Column Disease Group listed in this column 17 Diabetes with Acute Complications 18, 19.
Terminology •HCC- Hierarchical Condition Categories – Chronic conditions used to create a risk adjustment methodology (PART A,B,C) •RX HCC –Some HCC codes adjust risk due
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