HCC model concepts, MEAT documentation criteria, chronic conditions that risk adjust, and audit pitfalls (CRC and CPC-style).
40 cards · basic cards · AI-written, checked twice. Edit anything.
- What does the acronym HCC stand for in risk adjustment coding?
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Hierarchical Condition Category- Which federal agency administers the HCC risk adjustment model used for Medicare Advantage?
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CMS (Centers for Medicare and Medicaid Services)- What does RAF stand for in risk adjustment?
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Risk Adjustment Factor- What does a patient's RAF score represent?
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A numeric prediction of that patient's expected health care costs relative to an average beneficiary- What two general categories of factors make up a CMS-HCC RAF score?
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Demographic factors and disease (HCC) factors- What does it mean for a beneficiary to be 'dual eligible' in risk adjustment?
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They are enrolled in both Medicare and Medicaid- In the MEAT documentation framework, the M stands for ____.
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Monitor- In the MEAT documentation framework, the E stands for ____.
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Evaluate- In the MEAT documentation framework, the A stands for ____.
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Assess or Address- In the MEAT documentation framework, the T stands for ____.
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Treat- Why does MEAT documentation matter for HCC coding?
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It shows the condition was actively managed at the visit, not just listed as history- Does listing a condition only on the problem list satisfy MEAT documentation requirements?
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No, the visit note itself must show monitoring, evaluation, assessment, or treatment- How often must a chronic HCC-qualifying condition be documented and coded to count toward a patient's current risk score?
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At least once every calendar year- What is the term for re-documenting and re-coding a chronic HCC condition each calendar year?
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Recapture- Why do chronic HCC conditions require annual recapture?
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Because risk scores reset each calendar year and are based only on that year's documented diagnoses
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