Model the financial impact of improving your plan's documentation and coding accuracy. See exactly how RAF score improvements translate to revenue — and whether your coding investments are paying off.
Drag the slider to model different levels of RAF improvement from better documentation and coding accuracy.
Select the programs you're considering. Costs are estimated annual amounts — adjust the custom field for your actual budget.
Medicare Advantage plan payments are directly tied to the Risk Adjustment Factor. Better documentation captures the true clinical complexity of your members, resulting in more accurate payments.
Providers document conditions with greater specificity (e.g., "Type 2 diabetes with chronic kidney disease" vs. "diabetes"). Each specificity improvement can capture additional HCCs.
Chart reviews and prospective coding identify conditions that were diagnosed but not coded to the appropriate HCC. Closing these gaps is the fastest path to RAF improvement.
CMS adjusts payments monthly based on RAF scores. Every 0.01 increase in average RAF translates to approximately $11 PMPM for a plan with a $1,100 benchmark — compounding across your entire membership.
Accurate coding doesn't just increase revenue — it protects it. CMS Risk Adjustment Data Validation (RADV) audits can claw back overpayments. Investing in coding accuracy reduces audit exposure.
BFI builds custom revenue impact models using your plan's actual data — member-level RAF analysis, HCC gap identification, and ROI-backed coding program recommendations.
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