Without MEAT documented to substantiate the diagnosis, CMS will reject the diagnosis due to lack of evidence by the provider. Ensuring that each diagnosis provides evidence that the provider is Monitoring, Evaluating, Assessing/addressing and treating the condition.Documenting each diagnosis in an assessment and care plan.Ensuring a proper progress note with the HPI, physical exam, and medical decision-making process.Documenting all conditions evaluated during each encounter.MEAT can help organizations avoid these costly overpayment mistakes by ensuring providers are: Among these were Healthfirst Health Plan, Inc., which was overpaid by $5.2 million, and Tufts Health Plan Inc., which received at least $3.7 million in net overpayments. In early 2022 alone, the Office of the Inspector General (OIG) sought to claw back millions in improper Medicare payments from several Medicaid Advantage organizations it found to be non-compliant with risk-adjusted programs. Costly Mistakesįailure to comply with audit-specific diagnosis codes carries a high cost. For example, if there is a history of colon cancer (Z85.038) and the patient is ordered to have a screening colonoscopy, be sure to include this information under the A/P. Will add Buspirone 15mg tablets once daily to medication regimen."įurther, providers should show evaluation and treatment for all conditions assessed during the encounter as well as ensure that the information is thoroughly documented, for example by including “history of” conditions that affect the current treatment plan. For example: “diabetes (E11.9) remains stable, will continue insulin 10 units daily" or "patient has panic type anxiety (F41.0) and the patient complains that breakthrough panic attacks have increased. Thus, an acceptable problem list must show evaluation and treatment for each condition that relates to an ICD code. If the diagnosis on the claim is not accurate or complete, it could result in a lower reimbursement rate. CMS focuses on these diagnoses to demonstrate the need for higher reimbursement rates for patients who have more serious conditions or problems to manage. This is where things get complicated just listing every diagnosis in the medical record does not adequately support a reported HCC code. It must also include the clinician’s assessment and/or care management plan. Most chronic conditions match to an HCC, which must be supported with documentation showing the presence of the disease/condition. Coding professionals need to review all documentation to assign appropriate ICD-10-CM diagnosis codes. Thorough and complete documentation of chronic condition diagnoses is essential to the risk adjustment and HCC process – and is where MEAT comes into play. This is vital, as value-based payment models such as Medicare Advantage and Accountable Care Organizations that require providers to carry greater financial risk are becoming the norm.
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