Free Risk Adjustment Tool

HCC RAF Score Estimator

For Medicare Advantage plans, your Risk Adjustment Factor (RAF) directly determines capitation revenue. An average RAF of 1.0 means average revenue — but most panels have RAF gaps of 0.10–0.30 due to incomplete HCC capture.

~4 min

Panel Demographics

Medicare Advantage Members / Patients *

Average Member Age

72 yrs

Current Average RAF Score

1.10

If unknown, use 1.0 (average). Dual-eligible panels avg 1.4–1.8

Capitation Rate per Member per Month (PMPM) ($) CMS 2024 national average: ~$1,050–$1,400 PMPM

HCC Capture Assessment

Chronic Conditions per Patient (avg)

3 avg

Estimated HCC Capture Rate (%)

75%

% of eligible HCC codes actually documented & coded. Best practice: 90%+

HCC codes must be diagnosed and documented by a qualified provider each plan year. This tool provides estimates only.