A RAF score that reflects your patients' true risk.
A risk adjustment factor (RAF) score summarizes how sick a patient population is, based on the chronic conditions documented each year. When conditions go undocumented, the score understates patient need — and the resources available to care for those patients shrink with it. ElevateCare 360's HCC Module surfaces documentation gaps before the visit, so the record reflects every patient accurately.
When documentation falls short, patients lose out.
Chronic conditions have to be documented every calendar year to count. Busy schedules, scattered records, and year-end reviews mean many of them aren't — and the picture of patient risk quietly erodes.
Documentation gaps
The average practice misses 5–6% of eligible risk-adjusting diagnoses per patient each year, so the population looks healthier on paper than it is.
Annual reset
Every chronic condition must be re-documented each year. A diagnosis captured last year counts for nothing this year unless it's addressed again.
Reactive reviews
Chart reviews often run in the fourth quarter, after most visits are over. The chance to evaluate the condition with the patient in the room is gone.
Audit exposure
Diagnoses added through retroactive chart review draw federal audit scrutiny. Accuracy has to be built in at the visit, not patched in afterward.
Prospective, not retrospective. Accurate, not aggressive.
The HCC Module puts the right information in front of clinicians before each visit, so conditions are evaluated and documented when the patient is there — and every suggestion is backed by evidence.
Step 1
Find suspected conditions
Claims history, medications, lab results, and prior documentation are analyzed to surface conditions that are likely present but not yet documented this year.
Step 2
Prepare before the visit
Each pre-visit summary lists the conditions to evaluate, with the supporting evidence linked to its source — so preparation takes minutes, not a chart dig.
Step 3
Document at the point of care
Clinicians confirm or rule out each condition during the visit. Only what the clinical evidence supports is documented, keeping the record defensible.
Step 4
Track accuracy over time
RAF scores and re-documentation progress are tracked by provider, panel, and condition, so leaders see where gaps cluster and where support is needed.
HCC Module · Risk accuracy
Sample dataDocumented RAF
1.24
Clinically supported RAF
1.50
460 suspected conditions to review before upcoming visits
Chronic conditions re-documented this year
Diabetes with complications
81%
Chronic kidney disease
67%
Heart failure
74%
Chronic lung disease
62%
ElevateIQ · Ask where documentation gaps cluster by provider or condition, and see how they affect your RAF score before the next visit.
Prospective
Review before every visit
Not retroactive year-end chart chases
Source-linked
Evidence behind every suggestion
Clinicians decide; the record stays defensible
5–6%
Of eligible diagnoses missed per patient
The industry gap the HCC Module is built to close
Frequently asked questions
What is a RAF score?
A risk adjustment factor (RAF) score is a number that reflects a patient's expected health needs relative to an average patient, based on age, demographics, and documented chronic conditions. Medicare Advantage and many value-based contracts use it so that organizations caring for sicker patients receive resources that match that need.
Why does an accurate RAF score matter?
If a patient's chronic conditions aren't documented, their RAF score understates how sick they are. Across a population, that means fewer resources for care management, outreach, and the programs those patients depend on. Accurate documentation keeps resources aligned with real patient need.
What's the difference between prospective and retrospective risk adjustment?
Retrospective review searches past charts for missed diagnoses after visits have happened. Prospective review identifies suspected conditions before the visit, so the clinician can evaluate and document them with the patient present. Prospective review is more accurate, better for patients, and carries less audit risk.
How does ElevateCare 360 keep risk adjustment compliant?
Every suspected condition is linked to its source evidence, and clinicians make the final call during the visit. Nothing is added to the record without clinical support, which keeps documentation defensible under federal audit scrutiny.
What are HCCs?
Hierarchical condition categories (HCCs) group related diagnoses into the condition categories used to calculate RAF scores. The HCC Module tracks which categories are documented, suspected, or due for re-documentation for each patient.