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The Centers for Medicare & Medicaid Services (CMS) introduced the Risk Adjustment Factor (RAF) model in 2004, which was designed to estimate future healthcare costs for patients. RAF scores are a critical component of value-based care, as they help predict healthcare resource utilization while adjusting for quality and costs for patients. With the introduction of the v28 HCC model, healthcare providers and organizations must be prepared for significant changes in the way they code and capture patient risk.
The v28 HCC model will impact multiple CMS programs, including Medicare Advantage, the Medicare Shared Savings Program (MSSP), and REACH. With this year’s RAF scores being factored into the blended transition model, healthcare organizations that fail to learn the requirements of v28 and develop a strategy to act now will lose out on valuable dollars.
Read on as we delve into the key aspects of the v28 HCC model, work to understand the model’s impact on RAF scores, and share strategies to help you conquer the transition.