Medicare and RAF Scores

Medicare and RAF Scores

Last summer Nivano Physicians embarked on its newest  adventure and brought back a Medicare new line of business. We are now excited to announce that we will be offering a second Medicare Advantage plan, through Imperial Health Holdings. With this new contract we can expand our services to a larger population. Specifically, this agreement will expand our reach to Alameda, Santa Clara and Yolo counties along with adding an option in Sacramento and Placer Counties. In less than a year, we have grown to more than 4,500 members and are looking to double that by the end of the year.

What is the Risk Adjustment Factor (RAF) score and why is it important? The RAF score is the process CMS uses to determine how much to pay the health plan for that member, and how much it is going to cost to provide care for that member for the year. It is imperative that a provider you report and code the patient’s disease burden with documentation of each health condition every year. This allows for early identification of illness, the ability to plan for the patient’s care, improved patient’s health outcomes and ultimately less costs.

Every year Medicare members are eligible for an Annual Routine Physical (G0438 & G0439) and Annual Wellness Visit (99381-99397). These are opportunities to evaluate their health and clinically code any diseases to be reported for their RAF score. New for 2020, these visits can be done via telemedicine. 

A Nivano provider relations representative will be reaching out to all Medicare providers to schedule a meeting, deliver Health Plan Toolkits and provide any additional resources. We look forward to working with you to offer the best care for these new members!