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. As millions of Baby Boomers enter their Medicare years, the focus is on how to effectively address the high prevalence of chronic conditions among Medicare beneficiaries. For example, from the Centers for Medicare & Medicaid (CMS) 2018 data, 57% of Medicare beneficiaries have been diagnosed with hypertension and 48% with hyperlipidemia (high cholesterol).

Also, according to the CMS 2018 data, over two-thirds of Medicare beneficiaries live with two or more chronic conditions, equating to 94% of the overall Medicare spending.

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. It must also include the clinical provider’s assessment and/or plan for managing the disease/condition. Most organizations use the “M.E.A.T.” criteria. The MEAT acronym in the medical industry is described as the following: Monitoring, Evaluation, Assessment, Treatment for documentation practices, ICD-10-CM diagnosis coding, and HCC assignments.

As a result, 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.

Remember, in summary, CMS “wipes the slate clean” every January 1. MA plans must recapture all chronic conditions 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

Furthermore, 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 M.E.A.T. criteria, review our Coding Support and HCC Consulting services to see how YES can help you today!

Additionally, review these informative YES HIM Consulting HCC resources:

• HCC Coding 101: How to Avoid Scrutiny as Risk Adjustment Schemes Come to Light
• Why is HCC Coding Important? YES Case Study Highlights HCCs & Healthcare Technology
• How an HCC Coding Audits Partner Can Help Your Facility
• HCC Consulting Case Study: Bridging the Gap Between Medical Software Companies & Coding
• How HCC Medical Coding Can Turn Your Healthcare Organization into a Profitable One
• Webinar Recap for HCCs Background and A Deeper Dive into M.E.A.T. Criteria
• Everything You Need to Know About the HCC Risk Adjustment Models
• Implement These Best Practices to Improve HCC Coding
• The Importance of Specificity in Documentation and Coding HCCs
• HCC Chronic Conditions and M.E.A.T. Criteria
• HCC Medicare Advantage Background and Overview
• The HCC Coding Specialist: Benefiting Payers, Providers, and Patients