Beyond MEAT: The 3 Common Operational Problems in Adopting HCC Coding that Providers Face

To facilitate full and accurate Hierarchical Condition Category (HCC) coding, it is crucial that providers take a disciplined approach to documenting medical encounters in patient records. The AAPC  suggests providers use the acronym “MEAT” to ensure accurate HCC coding and proper documentation:  

M – Monitoring signs, symptoms, disease progression, disease regression 

E – Evaluating test results, medication effectiveness, response to treatment 

A – Assessing/Addressing ordered tests, discussion, review records, counseling 

T – Treating medications, therapies, other modalities 

MEAT criteria are essential for a reliable risk adjustment program. They serve as the connective tissue between documentation, provider intervention, and claims coding. The viability of value-based care (VBC) depends on this alignment, as it ensures that money is flowing to organizations assuming the most risk, and patients with chronic conditions are being served appropriately.  

But there is more to the story. 

Before MEAT as a methodology can be implemented into your care team’s protocols, it is essential that clinicians understand the importance of accurate HCC coding. Providers are overworked, so new programs and processes may be met with resistance. Some providers may even be skeptical of VBC as a business model, asserting that it takes the focus off the needs of the patient and transfers focus to meeting the guidelines of these programs. Therefore, it is imperative that change management strategies be deployed early and often to reinforce the positive financial and clinical impacts of VBC. What leadership can and should do as part of this strategy is test and institute systems and programs that alleviate the perceived additional operational burden. Reducing friction within the care team’s processes lowers hurdles and can help stakeholders clearly see and appreciate the benefits of VBC. Multiple operational problems often arise as provider organizations transition to alternative payment models (APMs), but three in particular stand out. However, where shared challenges exist, so too do common solutions. 

Problem #1: In a fee-for-service revenue cycle, coding is relatively straightforward: claims consist of diagnostic or procedural codes for services provided to the patient. VBC payment models, when implemented appropriately, require a more comprehensive understanding of the patient’s medical history, culled from various sources and locations. When a patient is treated at multiple departments within a clinically integrated network (CIN) with separate EMRs, for example, consolidating all the diagnostic codes linked to HCCs becomes difficult. Doing it at scale is a Herculean effort without the right integrations and automation. In today’s current state of stretched financial resources, building operational capacity without increasing headcount is key.  

Suggestion(s): Empower clinical review specialists by giving them a more comprehensive view of each patient’s medical history, as well as tools that help them identify the most significant gaps in care.  If done prior to an encounter, it can reduce some of the burden on clinicians during the patient visit. It will also give clinicians more time to assess the MEAT requirements of new potential conditions. In addition, tools that simplify HCC recapture—e.g., Artificial Intelligence (AI) and Machine Learning (ML)—save time across the care team and ensure care continuity and effective revenue capture for chronic disease management. 

Problem #2: Once the care team begins to recognize HCC coding as a critical component of the organization’s business model, organizations need to identify the right deployment approach and provide effective support throughout implementation. Different health systems will have different approaches; however, organizations that try to move into APMs by simply asking their teams to take on additional processes or bolting new tools onto technology already in use could see pushback from care teams and coding staff. Value-based payment (VBP) participants would do well by easing into the transition: start with tools that are made for VBC, but are also able to mesh with the existing team structure and processes. 

Decisions also need to be made regarding HCC coding strategy. Will the HCC coding be addressed before, during or after the visit? Will suspected conditions pop up within the EMR, come through a paper list with the patient, or through an Epic Best Practice Advisory (BPA)? Will coders and clinicians collaborate through electronic queries, or in person? Clinicians, especially those with a background in Informatics, should be part of that decision-making process. Excluding them is a missed opportunity to hear how the planned approach will impact their day-to-day workflows, which can lead to a more challenging implementation process and even resentment of the program. 

Suggestion(s): Clinicians’ core purpose is to deliver quality care and help patients achieve better health outcomes, but they are inundated with work that distracts from that goal. It’s no surprise that the physician burnout rate has risen in recent years and, as of October 2022, stands at 53%. It is imperative that whatever tools and processes are deployed do not exacerbate provider burnout. Continued education is important, as is minimizing alert fatigue, duplicative work, and sifting through noisy, meaningless data. If leveraging alerts or pop-ups within the EMR, make sure it excludes suspected conditions that the provider has already addressed. Most importantly, ensure providers understand that a little time spent confirming or rejecting a suspected condition now will save a significant amount of time down the road.  

Clinicians are the tip of the spear in ensuring MEAT criteria are met, documentation is complete, and coding is accurate. But they need a supporting cast who is engaged, educated, and has the right tools for their roles. Clinical Documentation Improvement (CDI), compliance and coding teams should conduct regular audits through retrospective reviews to make sure HCC codes are accurate and appropriate documentation exists. No organization wants to be the subject in another headline about unsubstantiated coding practices. 

Problem #3: Even care teams that have fully bought into VBC and are equipped with automation and tools that support collaboration may still find themselves coding inconsistently. Leadership needs provider-level visibility of their coding efficacy to understand where education or resources need to be deployed. That can be challenging without clear, data-driven insights into provider quality risk operations, etc.  

Suggestion(s): Start with the end goal in mind: show providers HCC’s role in improving patient outcomes. With the right visibility in place, providers can start building patient registries, identify where the patients are, and build standard care pathways to ensure patients are on the appropriate medicines or are getting the correct referrals. Leadership can then identify variations in care and gather the clinicians to share knowledge. Treating HCC coding as a discipline—rather than as an administrative or financial concept, which is how many providers regard it—helps ensure providers and the coding team are aligned, thereby driving improvements in patient outcomes.  Organizations with confidence to move into higher risk sharing arrangements have automation and NLP to drive scalability, collaborative tools to allow the whole care team to work in unison, and performance analytics to help the whole care team continue to improve. 

The MEAT criteria is a useful guideline to help the care team and coders ensure that HCC coding accurately reflects the true disease burden of patient populations. But following the guidelines in practice is challenging without the necessary systems and technology infrastructure in place to support it. Health systems participating in VBC arrangements too often try to solve new problems with old solutions. The right operational components to support automation, visibility, and collaboration, will create organizational efficiencies that lead to increased clinician satisfaction, improved financial performance, and better clinical outcomes.