Goals of Risk Adjustment

Through Risk Adjustment Factor, Premier Health Group aims to create an accurate profile of the health of our members, thereby improving their care and that of future patients.

An important step of RAF is completion of Patient Assessment Forms (PAF) for qualifying patients. This forms allows us to pinpoint chronic conditions in our member population. The PAF is completed by the provider, and details chronic conditions and current treatment, where applicable. The PAF requires the following:

  • Member name
  • Member DOB
  • Encounter date
  • Provider name
  • Provider NPI

To learn more about completing PAFs, read our step-by-step guide.

PAF Frequently Asked Questions

Do I have to see the member in the office before I can fill out and submit this form?
Yes. Risk Adjustment coding requires that a member be seen during a face-to-face visit. Please see the member like you normally would, making sure to discuss his/her chronic medical conditions. Then, in the EMR, please document those conditions and the current treatment plan for each.  

I did not address or bill the member’s chronic conditions the last time he/she was here. Am I able to go back into the record and amend it?
No. Medicare does not allow providers to amend records for Risk Adjustment purposes.   Validate and assess the member’s chronic conditions when he/she returns to the office for a face-to-face visit.  

Am I able to fill out the Assessment Form based off of a previous office visit?
Yes. You may use any visits in the current calendar year. 

Can a provider other than the PCP perform a RAF assessment encounter?
MDs, DOs, Nurse Practitioners, and Physician Assistants are able to perform a RAF assessment encounter. Encounters must be face-to-face and occur in hospital, physician office, clinic, specialist office, or residential long term care facilities, or in home visits.

The member does NOT have any of the chronic conditions listed on your form. Should I still fill out the worksheet?
Yes. Please check the box next to the condition that says ‘reject’, sign, and return the form.  

Do I have to complete an assessment form every time the member comes into the office?
Identification, evaluation and management of a member’s chronic conditions is part of the primary care physician’s role at every visit. The primary care physician documents and bills his assessment of the member’s primary reason for the visit and all associated comorbidities. Therefore a RAF assessment is being done at each visit. This assessment form is a reminder to the doctor of which chronic conditions have historically been billed for his/her member and it should be used to assist the provider during the visit.

If an Advanced Practitioner sees a Premier member does the assigned PCP sign off on the Assessment Form?
Either the PCP or the Advanced Practitioner can sign off. 

When does the PAF need to be submitted? 
All PAF’s must be submitted by no later than 8/1/2016. 

Who should I contact if I have a question about HCC coding or filling out the Assessment Form?

Tanya Jackson, BS
[email protected]
(937) 499-7447 Office
(937) 248-3289 Cell