Meet MEAT criteria to shore up your risk adjustment coding against denial

By Joanne Wilson, RN, ASN, CCDS, Senior Director, Solutions

Monitoring, evaluating, assessing, or treating—also known as MEAT—is a well-known and helpful concept organizations and coding professionals should use in the risk adjustment space.

Adequate MEAT criteria can shore up claims from denial and prevent costly takebacks from auditing agencies—and remove the bullseye from your organization’s back for a potential larger audit.

Let’s break the MEAT acronym down further with some specific examples.

• (M)onitoring: The watching or follow-up of a condition. A provider may document their monitoring of disease progression/regression, signs and symptoms, etc. For example, a patient with type 2 diabetes comes in for a six-month follow up. This establishes that the provider is monitoring the patient’s diabetes progression since the prior visit.

• (E)valuating: Documentation that the provider has reviewed labs/imaging, tests, physical exam/objective findings, medication effectiveness/responses to treatment, or provided discussion/counseling. For example, “I’ve ordered a HGBA1C,” or, “I’ve ordered Microalbumin/Creatinine Urine Ratio.”

• (A)ssessing: Determining whether the condition is stable or unstable, at goal or not at goal, in exacerbation, or progressing to evident diabetic complications, etc. For example, the provider documents that they have reviewed the patient’s HGBA1C and interpreted the results.

• (T)reating: The provider documents they’re providing treatment that includes medications, surgery, PT/OT/speech, hormone therapy, immunotherapy, hospice/palliative care. Note this may also include therapies like CMT or acupuncture. For example, “continue Metformin” would satisfy documentation of treatment.

Note that you don’t have to “meet” (pun intended) all four MEAT criteria to report a diagnosis for risk adjustment purposes. Just one is sufficient. But of course, getting more MEAT into the body of the record is always preferable.

A true best practice example of adequate MEAT criteria documentation: “Type 2 DM is stable without complications. HGBA1C results are 6.0, no changes to Metformin dosages, and return in six months.”

Yes, it’s perhaps unrealistic (even utopian) to expect this level of clinical support in an average OP encounter. But a girl can dream.

A couple final tips related to chronic conditions capture for risk adjustment:

• Chronic conditions should not be coded from the past medical history or problem list without a correlating statement from the provider that the conditions being reported affect the patient’s care and/or management.

• Every condition being reported must have supporting documentation that the provider is addressing that condition, or that it affects the patient’s care.

A best practice is to ensure the reported conditions are managed or addressed by the provider, or documented as affecting the care/management of a patient. A good OP CDI specialist or trained coding professional can make an impact here through education.

What type of MEAT criteria do you look for when reviewing outpatient encounters? What do you encourage/educate your providers to document to shore up your claims?

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Questions or comments on this article? Contact Wilson at joanne@norwood.com. If you need help with your organization’s risk adjustment coding, contact us at solutions@norwood.com.