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Medicare Advantage
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Mapping Conditions to HCC and RAF Score
coding-hcc-risk-adjustment
maziyarpanahi/openmed
380
This skill maps chronic conditions extracted from clinical notes to CMS-HCC V28 categories. It estimates the Risk Adjustment Factor (RAF) score, which is crucial for Medicare Advantage payments. It serves as decision support for coders by identifying candidate HCCs, applying complex coding hierarchies, and checking for MEAT documentation evidence for human validation.
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