In a year over year comparison, the total number of patients with the more specific...

This question applies the outpatient risk adjustment “reserve” concept: predicted cost is estimated by multiplying the member’s risk factor contribution by a baseline per-member-per-month (PMPM) amount, then annualizing. The morbid obesity HCC factor is 0.186, and PMPM is $800. First compute the monthly cost impact: $800 × 0.186 = $148.80 per month per patient. Convert to yearly: $148.80 × 12 = $1,785.60 per patient per year. The year-over-year increase in patients with morbid obesity documentation is 11,000 − 10,000 = 1,000 additional patients. Multiply the annual per-patient impact by the additional patient count: $1,785.60 × 1,000 = $1,785,600. Outpatient CDI programs emphasize that improving documentation specificity (when clinically supported) can change whether an HCC is captured, which can affect RAF-based projections and resource planning. However, documentation must still be accurate, supported, and reflect conditions assessed/managed during the encounter.