Talk of The Villages Florida - View Single Post - Potential Fallout - Beyond Healthcare - of TVHC's Massive Medicare Overbilling
View Single Post
 
Old 08-19-2025, 01:57 PM
Rainger99 Rainger99 is offline
Sage
Join Date: Oct 2021
Posts: 2,849
Thanks: 1
Thanked 2,136 Times in 1,005 Posts
Default

Quote:
Originally Posted by Bill14564 View Post
Honest question that should require some introspection: What would you do with the score if you had it?

Would you tell Medicare that they recorded it incorrectly?
Would you tell your MA plan that they calculated it incorrectly?
Would you tell your physicians that they documented (coded) your care incrorrectly?
Are you qualified to do any of the above?

You get a yearly physical and see a dermatologist twice a year. I get a yearly physical but don't see a dermatologist at all. Given that you visit an office three times as often as I do (or more if you have to contact the PCP for the dermatologist referral) shouldn't your score be higher than mine? I honestly don't know the answer to that which is why I would not think to ask about my score.
The main reason is curiosity. I am curious to find out how healthy Medicare has me coded. I think I am in fantastic health but I would like to know if Medicare agrees with me. I would expect a less than 1.0 so if it were significantly higher than 1, I might ask Medicare to review my records to see if they are accurate. I believe in transparency.

Don't you like to know your credit score? It used to be difficult to get your credit rating, but it is much easier now. That is important because if there are mistakes, it really impacts you. Several years ago, I checked my credit rating and they had someone with a similar name but it wasn't me. I asked them to change it.

A week ago, I had never heard of RAF scoring. However, since RAF rating appears to be one of the major factors in TVH bankruptcy, I am concerned that my RAF might be inflated.

Also, I am in Advantage right now and I am considering moving to Medicare next year. However, if I have an elevated RAF score, it might prevent me from transferring.

I found this article on the internet. Check out how complicated it is!!

Diagnosis Coding for Value-Based Payment: A Quick Reference Tool | AAFP