Meat medical coding11/13/2023 ![]() Assess/Address through discussion, records review, counseling, acknowledging, and/or documenting the status/level of condition.Evaluate via test results, medication effectiveness, response to treatment, and physical exam findings.Monitor for signs, symptoms, disease progression, and disease regression.MEAT stands for the four factors that establish the presence of a diagnosis during a face-to-face patient encounter and ensure proper documentation: To ensure this is the case, many organizations use the “MEAT” criteria for their documentation practices along with Hierarchical Condition Category (HCC) assignments and ICD-10-CM diagnosis coding. As such, physicians must clearly and precisely document each diagnosis based on clinical medical record documentation from a face-to-face encounter – which means that diagnoses cannot be completely determined from test results and a patient’s past medical history. A number of health plans have learned this the hard way, with OIG investigations netting clawbacks as high as $54.3 million from SCAN Health Plan and $34.4 million from HumanaChoice (administered by Humana, Inc.) due to non-compliance with risk-adjusted programs.Īs we discussed in a recent For the Record article, Documentation Dilemmas: Does Your Documentation Meet the MEAT Criteria?, ICD-10-CM Coding Guidelines state that all documented conditions coexisting at the time of an encounter that require or affect patient care treatment or management must be coded as a diagnosis. You need JavaScript enabled to view it.When it comes to risk adjustment and Hierarchical Condition Category (HCC), proper documentation and coding are all that stand between a healthcare organization and the potential loss of millions of dollars when the Office of the Inspector General (OIG) comes calling. For more information, please call 1-80 or email This email address is being protected from spambots. Her highly-trained staff provide personal and comprehensive medical practice management services – including Coding, clinical documentation training, risk adjustment management coding and managed hosting services. ![]() Nancy Rowe CPC, CPMA, CRC is the founder and president of Practice Providers Corporation. You can also work with a member of the American Association of Professional Coders, who are highly trained specialists in documentation, billing and health care compliance. ![]() You should be reviewing the encounter level for each patient to make sure that it properly reflects the conditions treated and the complexity of the visit. Training on your EMR system is essential for both you and your staff. How can I make sure my records are correct?Īs a physician, you have the ultimate responsibility for patient records. Insurance companies will request charts and – if the documentation does not support the E&M codes submitted– they will recoup payments. Submitting a higher than normal number of high level E&M codes can trigger an audit. Insurance carriers look at the billing trends in each practice. What happens my bill doesn’t comply with the MEAT criteria? What happened during the appointment must be thoroughly documented in the patient notes. The degree of decision-making should be commensurate with the length and complexity of the visit. A teenager with a sore throat requires far less decision-making than an obese senior with complications from diabetes. The purpose of MEAT is to fairly compensate doctors, based on the required level of decision-making during the appointment.
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