Male (65-69)
Male (70-74)
Male (75-79)
Male (80-84)
Female (65-69)
Female (70-74)
Female (75-79)
Female (80-84)
Non-Dual Eligible
Full Dual Eligible
Partial Dual Eligible
Step 2: Chronic Conditions (ICD Mappings)
Step 3: Interaction Factors
Estimated Risk Adjustment Factor
0.000
Understanding HCC Rates and RAF Scores
The Hierarchical Condition Category (HCC) model is a risk-adjustment system used by CMS (Centers for Medicare & Medicaid Services) to estimate future health care costs for patients. This calculator uses a simplified version of the CMS-HCC model to determine a patient's Risk Adjustment Factor (RAF) score.
How the Calculation Works
A patient's total RAF score is the sum of several distinct coefficients:
Demographic Variables: Based on age, gender, and whether the patient is eligible for both Medicare and Medicaid (Dual Eligibility).
Clinical Diagnosis: Based on ICD-10 codes mapped to specific HCC categories. If a patient has multiple diagnoses within the same hierarchy (e.g., three different types of heart disease), only the most severe category is counted.
Interaction Factors: Certain combinations of chronic conditions (like CHF and COPD) carry a higher risk than the sum of their individual parts, resulting in an additional "interaction" bonus to the score.
Real-World Example
Factor
Coefficient
72-Year-Old Male (Base)
0.385
Diabetes with Complications (HCC 18)
0.302
Congestive Heart Failure (HCC 85)
0.368
Total RAF Score
1.055
A score of 1.000 represents the average expected cost for a Medicare beneficiary. A score of 1.055 suggests this patient is 5.5% more expensive to treat than the average patient.
function calculateRAF() {
var baseScore = parseFloat(document.getElementById("ageGroup").value);
var eligibilityScore = parseFloat(document.getElementById("eligibility").value);
var conditionTotal = 0;
// Sum condition checkboxes
var checkboxes = document.getElementsByClassName("hcc-check");
for (var i = 0; i < checkboxes.length; i++) {
if (checkboxes[i].checked) {
conditionTotal += parseFloat(checkboxes[i].value);
}
}
// Sum Interaction checkboxes
var chfCopd = document.getElementById("chf_copd");
if (chfCopd.checked) {
conditionTotal += parseFloat(chfCopd.value);
}
var dmChf = document.getElementById("dm_chf");
if (dmChf.checked) {
conditionTotal += parseFloat(dmChf.value);
}
var totalRAF = baseScore + eligibilityScore + conditionTotal;
// Display result
document.getElementById("resultsArea").style.display = "block";
document.getElementById("totalRAF").innerHTML = totalRAF.toFixed(3);
var interpretation = "";
if (totalRAF < 1.0) {
interpretation = "This patient has a lower health risk profile compared to the average Medicare beneficiary.";
} else if (totalRAF === 1.0) {
interpretation = "This patient represents the average cost and risk of the Medicare population.";
} else {
interpretation = "This patient has a higher-than-average risk profile, indicating complex healthcare needs.";
}
document.getElementById("rafExplanation").innerHTML = interpretation;
}