HCC Chronic Conditions and M.E.A.T. Criteria

HCC Chronic Conditions and M.E.A.T. Criteria

 

HCC Chronic Conditions

As a follow-up to our previous articles “The HCC Coding Specialist: Benefiting payers, providers, and patients” and “HCC Medicare Advantage background and overview,” we now review HCC chronic conditions and the M.E.A.T. documentation criteria.

Do you need HCC consulting or coding support? Assigning HCCs can be a difficult task, especially for medical technology and software companies that need help navigating coding and documentation guidelines.  If your organization struggles with the HCC MEAT criteria, review our Coding Support and HCC Consulting services to see how YES can help you today!

HCC risk adjustment is a fundamental method in health insurance payer programs to account for the overall health and medical costs expectations of each individual enrolled in a health plan. Currently, as millions of Baby Boomers enter their Medicare years, the focus is now on how to effectively address the high prevalence of chronic conditions among Medicare beneficiaries. For example, from the Centers for Medicare & Medicaid (CMS) 2017 data, 57% of Medicare beneficiaries have been diagnosed with hypertension and 41% with hyperlipidemia (high cholesterol).

MEAT Criteria

Also, according to the most recent CMS 2017 data, over two-thirds of Medicare beneficiaries are living with two or more chronic conditions, which equates to 94% of the overall Medicare spending.

MEAT Criteria

Active, efficient, and effective management of these chronic conditions is critical. It ensures that Medicare beneficiaries receive the best possible care. And that the Medicare program is sustainable. Accurate, complete MEAT documentation of CC diagnoses by clinicians is an essential component of the risk adjustment and HCC process. Providers are required to document all conditions evaluated during every face‐to‐face visit.

M.E.A.T. Criteria for Documentation

Coding professionals need to review the entire medical record documentation to assign appropriate ICD-10-CM diagnosis codes. Most chronic conditions match to an HCC. To support an HCC, documentation must support the presence of the disease/condition. Additionally, it must also include the clinical provider’s assessment and/or plan for management of the disease/condition. Most organizations use the “M.E.A.T.” criteria. Monitoring, Evaluation, Assessment, Treatment for their documentation practices. As well as ICD-10-CM diagnosis coding and HCC assignments.

MEAT Criteria

The CMS conducts risk adjustment data validation (RADV) to ensure the accuracy and integrity of risk adjustment data. Providers submit the data for Medicare Advantage (MA) risk adjustment payments. RADV is the verification process of diagnosis codes for payment by a MA organization. This process confirms they are supported by medical record documentation. Simply listing every diagnosis in a problem list does not support a reported HCC code.

m.e.a.t. criteria

Remember, in summary, CMS “wipes the slate clean” every January 1. MA plans must recapture all chronic conditions in order to receive reimbursement. Now is the time to review your providers’ documentation practices and coding guidelines. Utilizing the CMS HCC MEAT criteria for provider documentation is the most effective way to ensure MEAT HCC coding accuracy.

Next Steps

Do you need HCC consulting or coding support? Assigning HCCs can be a difficult task, especially for medical technology and software companies that need help navigating coding and documentation guidelines. If your organization struggles with the HCC MEAT criteria, review our Coding Support and HCC Consulting services to see how YES can help you today!

Karen Youmans

Karen G. Youmans, MPA, RHIA, CCS – President, YES HIM Consulting, Inc. AHIMA-approved ICD-10-CM/PCS trainer
M.E.A.T. Criteria

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