“The first day, the line was two blocks long with a two-hour wait in the restaurant,” Chandler-Baker said. She opened the Hyde Park location in a small storefront primarily for takeout in April 2019. (Terrence Antonio James / Chicago Tribune)
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Utilizing the CMS HCC MEAT criteria for provider documentation is one of the most effective ways to ensure MEAT HCC coding accuracy.ĭo you need HCC consulting or coding support? Assigning HCCs can be a difficult task, especially for medical technology and software companies who need help navigating coding and documentation guidelines.Neon lighting reading "Vegan Vibes" at the restaurant Can't Believe It's Not Meat in Old Town. Now is the time to review your providers’ documentation practices and coding guidelines. Remember, CMS “wipes the slate clean” every January 1, so MA plans must recapture all chronic conditions in order to receive reimbursement. Simply listing every diagnosis in a problem list does not support a reported HCC code. RADV is the process of verifying that diagnosis codes submitted for payment by a MA organization are supported by medical record documentation. The CMS conducts risk adjustment data validation (RADV) to ensure the accuracy and integrity of risk adjustment data submitted for Medicare Advantage (MA) risk adjustment payments. Most organizations use the “M.E.A.T.” criteria: Monitoring, Evaluation, Assessment, Treatment for their documentation practices, as well as ICD-10-CM diagnosis coding and HCC assignments. To support an HCC, documentation must support the presence of the disease/condition, and also include the clinical provider’s assessment and/or plan for management of the disease/condition. Most chronic conditions are assigned to an HCC. Providers are required to document all conditions evaluated during every face‐to‐face visit.Ĭoding professionals need to review the entire medical record documentation to assign appropriate ICD-10-CM diagnosis codes.
Accurate and complete MEAT documentation of chronic condition diagnoses by clinicians is an essential component of the risk adjustment and HCC process. For example, from the Centers for Medicare & Medicaid (CMS) 2017 data, 57% of Medicare beneficiaries have been diagnosed with hypertension and 41% with hyperlipidemia (high cholesterol).Īlso, according to the most recent CMS 2017 data, over two-thirds of Medicare beneficiaries are living with two or more chronic conditions, which equates to 94% of the overall Medicare spending.Īctive, efficient, and effective management of these chronic conditions is critical to ensuring that Medicare beneficiaries receive the best possible care and that the Medicare program is sustainable.
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Currently, as millions of Baby Boomers enter their Medicare years, the focus is now on how to effectively address the high prevalence of chronic conditions among Medicare beneficiaries. HCC risk adjustment is a fundamental method used in health insurance payer programs to account for the overall health and expected medical costs of each individual enrolled in a healthplan.
If your organization struggles with the HCC MEAT criteria, review our Coding Support and HCC Consulting services to see how YES can help you today! documentation criteria.ĭo you need HCC consulting or coding support? Assigning HCCs can be a difficult task, especially for medical technology and software companies who need help navigating coding and documentation guidelines.
CriteriaĪs a follow-up to our previous articles “The HCC Coding Specialist: Benefiting payers, providers, and patients” and “HCC Medicare Advantage background and overview,” we now review HCC chronic conditions and the M.E.A.T.