Webinar Recap for HCCs background and a deeper dive into M.E.A.T. Criteria
In conjunction with TruCode’s Educational Series of free webinars, YES President and CEO, Karen Youmans hosted a webinar focused on HCC education and coding, and the application of the M.E.A.T. Criteria. The webinar, which was held twice due to popular demand, was attended by over 3,000 HIM professionals. If you missed the opportunity to attend either session, you can download the presentation slides here.
We will recap the main points made during the webinar, and provide additional resources to help you and your organization become HCC experts.
Overview of HCC Education & Medicare Advantage
Hierarchical Condition Categories is a risk adjustment model that predicts potential healthcare costs that a patient could incur in the future. This risk adjustment model is being used more and more as the industry transitions to value-based payment models. Accurate HCC coding captures patient complexity, and ensures that the level of care and reimbursement payments are specifically tailored to treat that patient.
The Medicare Advantage program is slightly different from the original Medicare in that it is considered the “all in one” alternative to the original. These “bundled” plans include Medicare Part A (hospital insurance), Part B (medical insurance), and usually Part D (Medicare Prescription Drug Plan). Extra benefits that the original Medicare doesn’t cover may also be included. Our article, “HCC Medicare Advantage Background Overview,” dives deeper into the mechanics of Medicare Advantage.
CMS-HCC Model vs. HSS-HCC Model
The CMS-HCC model is mainly used for reimbursement of Part C claims through Medicare Advantage, and is utilized by Medicare beneficiaries and disabled patients. This model also determines the expected costs for the following year. The HHS-HCC model is primarily used to pay for Health Exchange plans under the Affordable Care Act, covering patients of all ages. This model determines future costs for the current year. Review the details of both models in our article, “HCC Medicare Advantage Background Overview.”
Application of M.E.A.T. Criteria & Importance of Specificity in Coding
Accurate and complete documentation of chronic conditions is a critical component of HCC coding and the risk adjustment process. The latest CMS 2017 data shows that more than two-thirds of Medicare beneficiaries have two or more chronic conditions (CMS, 2019). To justify an HCC code, documentation must include a disease/condition and the provider’s plan on how to treat the disease/condition. Most providers use the M.E.A.T. criteria (monitoring, evaluation, assessment, treatment) to ensure their documentation is complete, thorough, and accurate. Review our article, “HCC Chronic Conditions and M.E.A.T. Criteria,” for more information on chronic conditions and how to use the M.E.A.T. criteria.
Specificity directly impacts a patient’s risk adjustment score and treatments, which are linked to the HCC assignment and payments. An incorrect assignment could mean thousands of dollars in lost revenue or revenue collected from overcoding, leading to compliance risks for your organization. Examples of how specificity can affect documentation, HCC assignments, and reimbursement payments can be found in our article, “The Importance of Specificity in Documentation and Coding HCCs.” It’s important to remember that CMS begins the revenue contracting again every January 1, so Medicare Advantage plans must document and submit chronic conditions each and every year to receive payments.
YES HIM Consulting has experience in consulting different nationwide organizations on the HCC risk adjustment models, as well as providing HCC education and coding support. If you would like to receive a quote for our consulting services, contact YES today!