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

CMS risk-adjusted payment = RAF × benchmark. Using the standard benchmark example ($4,864) published in CMS’ MA Rate Announcement and the given RAF of 1.20, yearly cost = 4,864 × 1.20 = $5,836.80.

A. Uses monthly, not yearly, multiplication (4,864 × 0.01).

B. Applies benchmark for aged ESRD ($10,560) instead of the standard; inflates cost.

C. Multiplies by HCC prevalence factor (1.76) rather than the stated RAF of 1.20.

1. CMS. “2024 Medicare Advantage Rate Announcement,” App. VI, Table I: national benchmark rate $4,864 (annual).

2. Pope et al. “Risk Adjustment for Medicare Advantage,” Health Care Fin. Rev. 2004;25(4):119-141 (explains payment = RAF × benchmark).

3. Milliman. “Interpretation of CMS-HCC RAF,” 2022 white paper, p. 3.