Payer & Provider Solution

Streamline Chart Prioritization & Clinical Documentation Improvement

The RAF Score Calculator integrates demographic, diagnosis, and disease interaction data to assess patient health status and resource utilization needs. Process up to 50 ICD-10 diagnosis codes and calculate risk scores across multiple dimensions including age, gender, community/institutional status, and dual/non-dual enrollment factors.

Our tool identifies high-value missed diagnostic opportunities with financial projections, enabling coders to prioritize charts for CDI while preventing wasted effort on low-impact recommendations. Generate detailed Revenue Impact Reports with downloadable PDF summaries for comprehensive risk analysis.

For real-time integration capabilities, explore our RAF Score API or process large patient populations with the RAF Batch API.

Instant RAF Calculations

Process up to 50 ICD-10 codes with immediate risk score results and HCC categorization

Revenue Impact Analysis

See direct financial implications of diagnosis documentation with MA payment estimates

Downloadable PDF Reports

Generate comprehensive reports with diagnosis validation and coding gap identification

Core Features

Powerful Calculation & Analysis Capabilities

From instant RAF score generation to comprehensive revenue impact analysis, this calculator transforms diagnosis data into actionable insights for CDI and chart prioritization.

Multi-Code Processing

Enter up to 50 ICD-10 diagnosis codes via manual entry or bulk paste with comma-separated values for efficient batch analysis.

Disease Interaction Analysis

RAF scores consider all patient ICDs together, accounting for disease interactions alongside individual diagnosis risk factors.

Code Validation & Categorization

Automatically flags diagnosis codes as Billed, Missed, or New to prioritize high-value CDI opportunities.

Revenue Impact Projection

Calculate estimated Medicare Advantage payments based on RAF scores to quantify the financial impact of documentation improvements.

HCC Categorization

View detailed HCC category assignments for each diagnosis with individual risk contributions to total RAF score.

PDF Report Generation

Download comprehensive Revenue Impact Reports with complete risk analysis and documentation gap summaries.

Model Support

Comprehensive CMS-HCC Model Coverage

Calculate RAF scores across all current and recent CMS-HCC models with support for diverse beneficiary categories and risk factors.

CMS-HCC V28 Models

Effective January 1, 2025 forward: Continuing Enrollee, New Enrollee, and C-SNP variants for comprehensive risk adjustment.

CMS-HCC V24 Models

Through December 31, 2024: Continuing Enrollee, New Enrollee, and C-SNP variants for historical and transitional analysis.

Calendar Year Models

CY2024 and CY2023 risk adjustment options for multi-year analysis and blended RAF score calculations.

ESRD Risk Models

ESRD-V24 variants including Dialysis, Functioning Graft, and Post-Transplant status for specialized kidney disease populations.

RxHCC-V08 Model

Prescription drug risk adjustment calculations for Part D benefits and Medicare Advantage D-SNP programs.

Comprehensive Risk Factors

Community NonDual/Dual (Aged/Disabled), Institutional (Disabled/Not-Disabled), and beneficiary-specific categories.

Key Users

Who Benefits from RAF Score Calculator

From clinical documentation specialists to revenue cycle teams, this tool enables precision risk assessment and resource allocation.

Clinical Documentation Improvement Teams

Streamline chart prioritization by identifying high-value missed opportunities, preventing wasted effort on low-impact diagnosis codes.

Healthcare Providers & Physicians

Shift from generalized to individualized patient risk assessment based on health complexity and projected resource utilization needs.

Medicare Advantage Plans

Enable precise resource allocation for plan members through accurate risk profiling and revenue impact projections tied to RAF scores.

Common Applications

Use Cases & Workflow Integration

From post-prospective chart reviews to documentation gap analysis, the RAF Score Calculator streamlines critical healthcare workflows.

Post-Prospective Chart Review

  • Quickly analyze patient charts after prospective coding reviews
  • Compare Billed, Missed, and New diagnosis code contributions to RAF scores
  • Prioritize high-impact charts for follow-up documentation

Revenue Impact Assessment

  • Calculate financial implications of documentation improvements
  • Project Medicare Advantage payment changes based on RAF score adjustments
  • Quantify value of CDI initiatives with concrete revenue estimates

Resource Allocation Planning

  • Assess patient health complexity for precise resource allocation
  • Identify high-risk patients requiring additional care coordination
  • Support transition from generalized to individualized care models
Key Advantages

Calculator Features & Benefits

From preventing wasted CDI effort to enabling data-driven chart prioritization, the RAF Score Calculator delivers measurable value.

50
ICD-10 Codes Supported

Process up to 50 diagnosis codes per calculation with bulk paste functionality for efficient analysis

FREE
Online Access

Sign up for free access to instant RAF calculations with downloadable PDF reports

1.00
Baseline HCC Risk Score

Scores above 1.00 indicate elevated resource needs requiring additional care coordination

ALL
CMS-HCC Models

Complete support for V24, V28, ESRD, RxHCC, and CY2023/CY2024 calendar year models

Start Calculating RAF Scores Today

Try our free online RAF Score Calculator and experience instant CMS-HCC risk adjustment calculations with comprehensive revenue impact analysis and downloadable PDF reports.

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