Certified Risk Adjustment Coder (CRC)

Which factors can impact the Risk Adjustment Factor (RAF) score?

1. Age of patient

2. Diagnosis manifestation reporting

3. Both age and diagnosis reporting

4. Only acute illness reporting

The correct answer is: Both age and diagnosis reporting

The Risk Adjustment Factor (RAF) score is influenced by various factors that reflect the health status of a patient population. The most significant contributors to the RAF score include the patient's age and the reporting of their diagnosis manifestations. Age of the patient plays a crucial role in the RAF score calculation. Generally, older patients are presumed to have more complex and comorbid health conditions, which typically lead to a higher RAF score. This is because health risk increases with age, and populations with older individuals are often at greater risk for chronic diseases. Diagnosis manifestation reporting also impacts the RAF score as it captures the chronic conditions and acuity of illnesses present in a patient. Accurate and comprehensive documentation of these diagnoses is essential, as each documented condition can contribute additional weight to the overall RAF score, reflecting the patient's health complexity and expected healthcare costs. Thus, the correct choice incorporates both age and diagnosis manifestation reporting, demonstrating the multifaceted nature of the factors that contribute to the Risk Adjustment Factor score.