![]() You might see documentation differ between providers, but as long as it meets the MEAT criteria or the TAMPER (treatment, assessment, monitor, plan, evaluate, and referral) criteria, a condition can be coded from anywhere in the note-except for the problem list.ĭo not code off the problem list unless it is specifically addressed in the note. Only one element of MEAT is needed, but the more elements included in the documentation, the better. ![]() “Treated” is any note about medication, therapy, surgery, or any other modality addressing treatment of the condition.“Assessed” is for whether there are any tests, discussion, review of records, or counseling.Is there some statement regarding medication efficacy or treatment response? For “evaluated,” look at whether there were test results.“Monitored” could be things such as signs or symptoms or disease progression or regression in the notes.As long as the documentation meets the MEAT (monitored, evaluated, assessed, treated) criteria, it can be reported from anywhere in the note. The coding guidelines don’t change with HCCs. If you need help finding the Provider Relations Consultant for your region, call Provider Services at 1-86.Q: What clinical documentation is acceptable to pull Hierarchical Condition Category (HCC) information from for reporting purposes? Would you code from history of present illness, past medical history, active problem list, or the assessment?Ī: Follow the coding guidelines when reporting diagnosis codes for HCC purposes. To learn more about Risk Adjustment Coding and how it will benefit your practice, contact your local Provider Relations Consultant. Treat: medications, therapies, other modalities.Assess/Address: ordering tests, discussion, review records, counseling.Evaluate: test results, medication effectiveness, response to treatment.Monitor: signs, symptoms, disease progression, disease regression, etc.MEAT is an acronym used to describe the four factors that help you establish the presence of a diagnosis during an encounter in proper documentation: The best practice is to follow the MEAT Documentation model. A list of diagnoses is not acceptable as evidence that the diagnosis affected the patient management. Each condition that relates to a code must reflect evaluation and/or treatment. ![]() What’s the best practice model for documentation?Įach and every condition that is addressed at the time of the patient encounter should be documented. By documenting this information, you help to ensure the integrity of the data used in calculating the overall health risk of your patients and contribute to improved care for those patients. This documentation must support the current presence of the diagnosed condition, and it must indicate your assessment and/or plan for managing the condition. The Centers for Medicare and Medicaid Services (CMS) requires that you include documentation supporting the submitted diagnosis in your patient’s medical record. Additionally, effective risk adjustment coding helps to streamline your claims process, which may result in faster reimbursement! What’s the provider’s role? In addition, risk adjustment supports your practice in meeting the reporting requirements of ICD-10-CM codes, including records accuracy and timely reporting of claims and encounter data. This ensures that your patients receive the appropriate level of care while supporting your efforts to coordinate their care. Increased coding accuracy helps to identify patients who may achieve better outcomes through individualized support services such as Care Management. Why should providers care about risk adjustment coding? Your patients may be assigned to more than one category because the combination of risk factors and demographic information may overlap to represent more than one type of illness. How does risk adjustment work?Ī risk adjustment value is assigned to each diagnosis code, which are grouped into a hierarchical condition category (HCC). Risk adjustment strategies can help health plans work collaboratively with providers to identify high-risk members to ensure that those members have all the tools and resources they need to better manage their health. It allows health plans to identify members with serious or chronic illnesses and assigns a risk factor score to those members based on a combination of their health conditions and other demographic factors. Risk Adjustment is a predictive modeling process that takes into account the underlying health status and health spending of patients. Risk Adjustment Coding: What Providers Need To Know
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