A Case Study in RAF Score Stabilization & Revenue Growth
Facing a significant decrease in Risk Adjustment Factor (RAF) scores, a medical group partnered with Intent Health to implement a proactive, multi-pronged approach to revenue cycle management. This case study details the problem and the strategic solution that led to remarkable financial and clinical outcomes.
The Strategic Approach: A Multi-faceted RCM Framework
Incorrect RAF score submissions, whether due to under-coding or over-coding, carry severe financial and operational risks that can undermine an organization’s long-term viability.
Data Analytics & Validation
Intent Health's analytics team used data to identify all previously missed HCC categories. Each missed opportunity was meticulously validated for the current year to ensure accuracy and compliance.
Proactive Documentation
For conditions not documented in the current year. the system generated alerts for upcoming patient visits. This empowered physicians to address and document these conditions, ensuring accurate risk scores.
Clinical Review & Addendums
A dedicated clinical team reviewed medical records for probable HCCs and requested addendums for conditions with missing documentation, adhering to the 180-day window from the date of service,
Financial Impact
The ACO provided additional incentives and increased the reimbursement rate for FY 2025, directly correlating with the improved RAF scores achieved through Intent Health’s strategic intervention.
Patients with Stable/ Increased RAF Scores
Patients with Lesser RAF Scores