An auditor finds an HCC-mapped diagnosis pulled only from an inactive problem list with no MEAT (monitored, evaluated, assessed, or treated) evidence in the year’s encounters. What integrity conclusion is most accurate?
Select an answer to reveal the explanation.
Short Explanation
A dusty problem-list line is not the same as “we dealt with it this visit.” Risk-adjustment integrity wants evidence the condition was monitored, evaluated, assessed, or treated. No MEAT in the encounter notes means that HCC claim is on thin ice.
Full Explanation
Compliant HCC capture depends on encounter documentation showing the condition was addressed—commonly framed as monitored, evaluated, assessed, or treated—not merely present on an inactive problem list. Historical mapping alone, CPT-focused MEAT myths, and “any ICD on the claim” assumptions do not meet risk-adjustment integrity expectations. Physician-office coding teams should validate clinical support before reporting HCC-relevant diagnoses for risk adjustment.