Our Patient 2: On Day 1, RAF based score for this patient was 0.7 – Based on demographics for an 82-year-old female ( age, sex, community vs. SNF, Medicare/Medicaid eligibility).
| Diagnoses per chart documentation | HCC | RAF |
| Base | N/A | RAF 0.7 |
| Total RAF = 0.7 |
Based on an average per patient-per month payout of $1,000, baseline annual payout with comorbidity conditions:
0.7 x $1,000 x 12 mos. = $8,400 per year
Our Patient 2: After initial review, MTC Health made following assessment: RAF base score 0.7, with more specific documentation of conditions and treatments.
| Diagnoses per chart documentation | HCC | RAF |
| Base | N/A | RAF 0.7 |
| DM | HCC 19 Tyoe II DM w/o Complications | RAF 0.105 |
| Obesity | None | |
| BMI 36 (STARS) | None | |
| HTN | None | |
| Insomnia | None | |
| Major Depression, single episode | None (severity not documented) | |
| Smoker | None | |
| PMH Breast C | None | |
| Total RAF = 0.805 |
Based on an average per patient-per month payout of $1,000, baseline annual payout with comorbidity conditions:
0.805 x $1,000 x 12 mos. = $9,660
Scenario 3: After thorough assessment and document review, MTC Health transformed RAF based score 0.7 with the help of even more specific documentation of conditions and treatments.
| Diagnoses per chart documentation | HCC | RAF |
| Base | N/A | RAF 0.7 |
| Type II DM with diabetic CKD | HCC 18 – Diabetes w/ complication | RAF 0.310 |
| + CDK Stage 4 | HC 137 | RAF 0.263 |
| Diabetic peripheral angiopathy | HC 108 (HC18 DM w/comp already assigned) | RAF 0.293 |
| Diabetic non-pressure foot ulcer, R heel | HCC 161 | RAF 0.525 |
| Amputation lower extremity L 2nd toe | HCC 189 | RAF 0.554 |
| Morbid Obesity (BMI 36 + DM, HTN due to obesity) | HCC 22 | RAF 0.262 |
| Hypertensive HF, chronic systolic HF | HCC 85 | RAF 0.327 |
| Major Depression, single episode, mild | HCC 59 | RAF 0.352 |
| Sedative-hypnotic Dependence, un- complicated | HCC 55 | RAF 0.356 |
| COPD | HCC 111 | RAF 0.332 |
| Metastatic CA to spine | HCC 8 | RAF 2.642 |
| Immuno suppressant status | HCC 47 | RAF 0.645 |
| Total RAF = 7.561 |
Based on an average per patient-per month payout of $1,000, baseline annual payout with comorbidity conditions:
6.916 x $1,000 x 12 mos. = $90,732
(Source: American Academy of Family Physicians)
The above example illustrates the significance of accurately coding and documenting all HCC conditions along with prevalent disease interactions. In this example, MTC Health increased reimbursements for this patient by $81,072 per year.