7/24/2023 0 Comments M.e.a.t. checklist hcc![]() In order to ensure HCC codes and documentation compliance, CMS checks health plans using targeted and random audits. It is clear that proper HCC medical coding and documentation is critical in ACOs, MA, and HVBP. With the introduction of the Medicare Advantage Plans and its requirement of RAF reimbursement scores, the HCC has become more popular.Īt the moment, every coding leader and the commercial payer is talking about HCC. The Hierarchical Condition Categories (HCC) is a risk-adjustment model that has existed for many years. So, what does HCC stand for in medical coding? However, there is no consecutive plan that everyone can follow. The role of the ACA is to ensure that patients get affordable health coverage regardless of the number of visits. ![]() These are people who rarely visit the doctor, and this ensures that they do not inflate or deny cover for ill patients. The Affordable Care Act (ACA) ensures that insurance companies don’t give healthy patients cheap insurance plans. ![]() In healthcare, however, this phrase does not apply. There is a saying that goes: “you get what you pay for.” This saying is applicable when you pay for a designer product or a vehicle. The Origin of HCC Medical Billing and Coding In this article, we will discuss everything about HCC coding, from its origin to its relationship with risk adjustment coding and its relationship with the MEAT framework. So, what is HCC in medical terms and what is HCC healthcare? This has resulted in Medicare paying a higher monthly capitation fee for patients with higher HCC scores as these require more resources and disease intervention. Costly chronic conditions of ICD-10-CM have been classified by CMS into Hierarchical Conditional Categories (HCCs).HCC scores have been used since 2004 by Medicare to adjust payments based on the risk level of the enrollee. Patients with HCC conditions require more resources and disease intervention. The Risk Adjustment process identifies patients who are more costly to care for based on the diagnosis codes billed for the patient in the previous review period. Proper HCC coding and documentation is critical for health care providers participating in risk-adjusted market of Accountable Care Organizations (ACOs), Medicare’s Hospital Value Based Program (HVBP), or Medicare Advantage (MA). Medicare wants payments to CMS-accepted organizations to be in line with the expected cost of care. To this end, CMS targets health plans with both random and targeted audits to confirm validity of diagnoses submitted. Submitting an inaccurate diagnosis or a diagnosis resulting in a different HCC poses a major compliance risk and will lead to payment recovery to Medicare. Any change in the HCC could mean that the provider is receiving too much or too little revenue. In both cases, the code would be considered invalid or discrepant. To stay compliant and mitigate risk of audits, healthcare providers must be well aware of the essentials that should be present in the medical record. One of the most critical and basic requirements is proper documentation of the diagnosis to capture the most accurate HCC code. For this, documentation should indicate the diagnoses being monitored, evaluated, assessed/addressed, or treated (M.E.A.T.). Monitor-signs, symptoms, disease progression, disease regression.is at the heart of HCC coding and clinical documentation and is defined as follows: stands for: M-monitoring, E-evaluating, A-assessing, and T-treatment. Evaluate-test results, medication effectiveness, response to treatment.Assess/Address-ordering tests, discussion, review records, counseling.Treat-medications, therapies, other modalities.These four factors help providers to establish the presence of a diagnosis during an encounter and ensure proper documentation. For medico-legal purposes, complete documentation provides evidence of a diagnosis, that is, “if it was not documented, it does not exist”.įor success with documentation, clinicians should make sure it adheres to M.E.A.T. Is not documented to validate the diagnosis, the diagnosis will be rejected by CMS due to the lack of evidence by provider.
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