HCC Coding Guide: RAF, MEAT & RADV Audit Readiness | Nym Health

HCC coding is how Medicare Advantage and other risk-based programs adjust payment for how sick patients are. CMS combines HCC-mapped diagnosis codes with demographic factors like age and sex to calculate a risk adjustment factor (RAF) score for each patient, which shapes what the plan is paid for that patient’s care. If your health system takes on risk through Medicare Advantage contracts or an accountable care organization, your documentation and coding drive those scores.