Why M.E.A.T. CRITERIA is important for HCC Risk Adjustment

We’ve discussed in our past blog how the MEAT (monitoring, evaluation, assessment, treatment) Criteria Model for coding is an excellent tool for monitoring key results and how it benefits partner organizations and stakeholders in achieving their business goals. In this article, we will explore the MEAT coding model’s advantages and how it can help improve your organization’s HCC risk adjustment scores.

Advantages of using the MEAT coding model:

Effective management of chronic conditions 

Management of chronic conditions is already a complex process for physicians because they need to update every so often in terms of diagnoses, symptoms, and new modes of treatment and procedures. As the physicians accomplish the updates, the risk adjustment and HCC process are also adjusted in real-time, and all relevant information is captured in the process. 

Now, documentation is another ballgame that requires the same amount of dedication, which is why it should be done actively, effectively, and efficiently at all levels of monitoring and planning. This is where the MEAT coding model of documentation comes in very handy as long as it is done accurately and completely by everyone on the team. Beneficiary patients also benefit from this comprehensive process because they get a complete claim on their Medicare benefits and are assured of optimum treatment and care at all times.

Accurate identification of risks and appropriate RAF scores

Complete documentation of every case for each beneficiary using the MEAT criteria impacts the entire process, from the hierarchical condition category (HCC) medical coding using the ICD-10-CM code set to the accurate identification of risks based on diagnosis/diagnoses and to the assigning of the appropriate risk values or risk adjustment factor (RAF) scores. When done efficiently with a complete understanding of the HCC coding guidelines by medical coders, it directly influences the annual coverage amount for Medicare beneficiaries and minimizes losses for the organization. 

Approved CMS risk adjustment data validation (RADV)

The Centers for Medicare & Medicaid Services (CMS) runs the risk adjustment data validation (RADV) process to verify that the actual diagnosis codes applied and submitted for payment comply with the HCC coding guidelines and are supported by the appropriate medical health records. Since CMS conducts RADV for every beneficiary claim for Medicare Advantage (MA) risk adjustment payment, it is crucial for the MEAT coding criteria to be competently implemented and thoroughly followed by the entire team, especially the medical coders, to ensure accuracy and validity of every payment claim, and therefore, a secured Medicare reimbursement. 

Maximized annual Medicare claims and reimbursement

Since Medicare claims are renewed and re-assessed yearly, commencing every 1st of January, it is critical to capture all chronic conditions of Medicare beneficiaries in order to receive proper and maximum reimbursement. So each year, all provider’s documentation of claims needs to be reviewed and accomplished using the MEAT criteria so as not to miss any detail in the medical records of patients. It cannot be emphasized more than it should be that in cases of chronic conditions or multiple organ diseases, all diagnoses need to be listed down for proper documentation and allocation of RAF scores. It is essential that all team members understand by heart the documentation practices and HCC coding guidelines; not just understand them but completely follow them.

Sufficient Medicare Advantage (MA) payment 

Accurate allocation of RAF scores ensures not only correct, but also, sufficient Medicare Advantage payments depending on the actual patient diagnosis or condition versus the expected medical costs. Therefore, the more chronic and complicated the disease, the higher the risk adjustment score, and the healthier a patient, the lower the RAF score; these can only be determined appropriately by using consistently and completely, the MEAT criteria in coding; doing this minimizes incorrect coding, claims disapproval or payment reduction.

Reliable RAF scores

It cannot be emphasized more that using the HCC codes precisely using the MEAT criteria will enable appropriate scoring for similar diagnoses but with varying degrees of severity or further complications. It is important to note that ICD-10-CM have varying costs and codes for similar conditions or diagnosis with different degrees of severity and complication. This must be captured in the documentation; otherwise, there can be overpayment or underpayment of claims. Therefore, mapping to an HCC and utilizing MEAT in calculating RAF scores, make a huge impact in payment accuracy.

Complete coding scores and process

To date, there are 79 HCC codes and over 9,000 ICD-10-CM codes that are being utilized for the Medicare risk adjustment payment model. Physicians and all healthcare team members need to be knowledgeable and experienced in assigning risk scores. The only way to do this is to use the MEAT criteria for coding so that thorough documentation of all diagnoses, including chronic conditions and complications, treatments, and procedures, are all documented and assigned appropriate scores. Progress reports need to be updated in real-time so as not to miss any patient information, including the history of present illness, physical exam results, nursing assessment notes, and the entire medical decision-making process.

Streamlined HCC coding using MEAT criteria

The best way to streamline the documentation process and make it up-to-par for HCC coding is to ALWAYS include MEAT (monitored, evaluated, assessed/addressed, and treated) in the patient medical records for each encounter. Notice that all the criteria are past-tense, meaning all must be done. Use it like a checklist of items required, things to be accomplished, and notes to be considered; maximize its use as a reminder.

To make the documentation easier, we will break down the process and show samples of items that must reflect in each criteria:

M – Monitoring signs, symptoms, syndromes, conditions, physical assessment results, disease progression, or disease regression

E – Evaluating test results, medication effectiveness, response to treatment or procedure, and surgical notes (if available)

A – Assessing/Addressing ordered laboratory tests, surgical procedures, discussion of management, review of patient history and health records, counseling requirements

T – Treating medications, procedures, therapies, and other relevant treatment modalities

There it is! Maximize the use of your MEAT coding criteria, and you’ll never be lost in the process; in fact, you will nail all the details and help in the improvement of the RAF scores for your organization.

Remember: A simple list of unthought-of diagnosis/diagnoses is not acceptable or valid from the official coding guidelines from HCC and CMS; it does not meet the criteria of a thorough assessment and planning used in assigning the risk adjustment scores. 

One final note, if you or your organization is looking to improve or augment your HCC coding process, you can do this in partnership with experts like Inferscience who can help all your stakeholders by providing a software tool that can accurately automate the tedious coding for the team, using the HCC Assistant


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