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ACDIS CCDS-O Exam - Topic 5 Question 10 Discussion

Calculate the expected yearly cost for this patient based on the RAF score.
D) $5,836.80
A) $486.40
B) $12,672.00
C) $17,011.20

ACDIS CCDS-O Exam - Topic 5 Question 10 Discussion

Actual exam question for ACDIS's CCDS-O exam
Question #: 10
Topic #: 5
[All CCDS-O Questions]

Calculate the expected yearly cost for this patient based on the RAF score.

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Suggested Answer: D

In outpatient risk adjustment (commonly Medicare Advantage), the patient's predicted cost is derived from the Risk Adjustment Factor (RAF), which is the sum of component risk contributions. Here, the RAF is calculated by adding the HCC diagnoses score (0.166), disease interactions (0.112), and demographic score (0.330). That total equals 0.608. The PMPM (per-member-per-month) baseline cost is $800. To estimate the patient's expected monthly cost, multiply PMPM by RAF: $800 0.608 = $486.40 per month. The question asks for the expected yearly cost, so convert PMPM to annual: $486.40 12 = $5,836.80. ACDIS outpatient CDI teaching emphasizes that accurate documentation and compliant coding directly affect RAF through captured HCCs and interactions (when supported), which in turn drives expected resource needs and plan payment. Missing or unsupported diagnoses can understate RAF; vague documentation can prevent valid HCC capture.


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Alexis
2 days ago
I think it's definitely B, that seems right.
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Carmela
7 days ago
The RAF score directly impacts the cost calculation.
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Reena
12 days ago
I’m confused about how to interpret the RAF score in relation to costs. I might just guess option D since it seems like a reasonable estimate.
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Ulysses
17 days ago
I feel like I’ve seen a question like this before, and I think it involved multiplying the RAF score by a specific dollar amount. Was it $1,200?
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Dierdre
22 days ago
I think the expected yearly cost is usually higher than what it seems at first glance. I’m leaning towards option B, but I’m not entirely sure.
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Myra
2 months ago
I remember we did a practice question similar to this, but I can't recall the exact formula we used for the RAF score calculations.
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