What is a RAF score?
A RAF score is a patient's Risk Adjustment Factor: the number a payer uses to predict cost and set payment. An average patient scores about 1.0. The score has exactly 2 inputs · demographics, and the diagnoses documented this year.
Written by Dr. Tattvam A. Nair, Co-Founder & COO of Layrd. Updated August 2026.
How the number is built
The score starts with demographic factors: age, sex, eligibility status. On top of that, each Hierarchical Condition Category documented for the patient this year adds its weight. The sum is the RAF score, and in Medicare Advantage and most value-based contracts, the monthly payment for the patient scales with it.
What moves it
Only documentation moves it. Not how sick the patient actually is, not what the problem list says, not what a specialist manages across town. A condition counts when it is addressed in a face-to-face encounter and coded, this calendar year, with enough specificity to land in the right category.
The reset
On January 1 every score rebuilds from zero. Last year's documentation earns nothing this year. This is the single fact that turns risk adjustment from a coding exercise into an operational one: every chronic condition on the panel has to pass through a note, every year, without exception.
Why sick panels get paid as healthy ones
When notes are thin, the model reads a complex panel as a simple one. The plan is paid for the panel it can see, and a practice in a value-based arrangement absorbs the difference: the cost of caring for the real patients against revenue set by the documented ones.
Where Layrd fits
Layrd writes each visit's note before the patient arrives, from everything in the record, and codes it as it is written: E&M with MDM justification, HCC mapping, care gaps. Every code cites the line of documentation it came from, so recorded complexity tracks real complexity without a retrospective review to reconcile them.
What is an average RAF score?
About 1.0, by construction. The model is calibrated so the average patient scores 1.0. A panel that is genuinely sicker than average but documents thinly can still score at or below it, and gets paid accordingly.
What is the difference between an HCC and a RAF score?
An HCC is a category a diagnosis falls into, with a weight attached. The RAF score is the sum: demographic factors plus the weights of every HCC documented that year.
Do RAF scores carry over from year to year?
No. The score is rebuilt each calendar year from that year's documented encounters. A chronic condition documented last year contributes nothing this year until it is documented again.
How does chart preparation affect RAF?
The note is the input. A note that carries every active condition, coded to specificity, is the entire mechanism by which a panel's real complexity becomes its recorded complexity. Layrd writes that note before the visit and maps the HCCs as it is coded.
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