RAF & HCC

Question 1

What does RAF stand for?

and what does it do?

Answer 1

risk adjustment factors

used to predict health care costs and determine hierarchal condition categories (HCC)

Question 2

T/F providers are paid more for patients who are at higher medical and financial risk due to the complexity of care provided

Answer 2

true

Question 3

accurate risk adjustment relies on ?

Answer 3

comprehensive medical record documentation

Question 4

what is considered low risk?

Answer 4

two or more minor problems
one stable chronic illness
acute uncomplicated illness or injury

Question 5

moderate risk?

Answer 5

one or more chronic illness with mild exacerbation or progression
two or more stable chronic illnesses
unidagnosed new problems with uncertain prognosis
acute illness with systmeic symptoms
acute complicated injury
prescription drug management

Question 6

HCC =?

Answer 6

higher risk

if a patient has an HCC diagnoses code they have an increased RISK of suffering sign. illness or death

Question 7

what does MEAT stand for

Answer 7

monitored
evaluated
addressed
treated
ensures each diagnosis is thoroughly supported

Question 8

what is required in every superbill

Answer 8

ICD code

E&M code