Instantly compute Risk Adjustment Factor scores — V24 & V28 CMS-HCC compliant — to maximize Medicare Advantage reimbursements with clinical precision.
Everything you need to know about Risk Adjustment Factors and how they impact your revenue.
A Risk Adjustment Factor (RAF) score is a numerical value assigned to Medicare Advantage beneficiaries based on their demographic data and chronic conditions (HCC codes). A higher RAF score reflects a sicker patient population, which directly drives higher CMS capitation payments to health plans.
RAF scores are the sum of demographic coefficients (age, sex, Medicaid status) plus HCC code coefficients from the patient's diagnosis history. Each HCC category carries a specific risk weight. Emedlogix automatically extracts and maps all applicable HCC codes to compute the most accurate composite RAF score.
CMS uses different model versions to calculate RAF scores. Our tool supports both active models simultaneously:
Legacy model — maintained for retrospective reviews
Current CMS model — primary scoring engine from 2024
Inaccurate or incomplete RAF scores lead to direct revenue loss. Our clients average a +38% revenue lift after deploying Emedlogix RAF optimization — driven by proper HCC capture, gap closure, and V28 migration compliance.
Connect with our HCC risk adjustment experts to see how Emedlogix can optimize your RAF capture.