Clinical documentation is an important and time-consuming part of a physician’s daily workflow. And with CMS ramping up Risk Adjustment Data Validation (RADV) audits, this task is sure to come under even greater scrutiny to ensure reported diagnoses accurately reflect what’s documented at the point of care.
Overburdened providers will likely face increased pressure to accurately capture diagnoses in their notes since it impacts how both health systems and payers are reimbursed. Most importantly, these notes determine whether a care provider’s efforts are recognized, resourced, and aligned with improving value-based care.
CMS expects providers to demonstrate that a diagnosis is supported by evidence, making clear and complete documentation more important than ever. However, accurately documenting diseases doesn’t have to mean more work – especially when following the M.E.A.T. framework.
So, what is M.E.A.T.?
M.E.A.T. stands for Monitor, Evaluate, Assess/Address, and Treat. Providers must align their documentation to these standards to demonstrate that a diagnosis is current, clinically relevant, and actively managed. These criteria help support Hierarchical Condition Category (HCC) coding, which is the engine behind risk-adjusted payments in value-based care.
Let’s break it down further:
Monitor: Documentation of the signs, symptoms, progression, regression, and ongoing surveillance of a chronic condition
Evaluate: Documentation of the current state of a chronic condition, physical exam findings, test results, medications prescribed, effectiveness of the care plan, and response to treatment
Assess/Address: Documentation of the discussions about a chronic condition, review of records, counseling provided, how a chronic condition will be evaluated, and whether the provider must order additional tests
Treat: Documentation of the care being offered for a chronic condition, medications prescribed or continued, specialist referrals, diagnostic study orders, therapeutic services (therapies) offered, other modalities, and a plan for managing the chronic condition
CMS mandates that providers only need to document one element of M.E.A.T. to support an active diagnosis for coding purposes – but the more complete a note, the better.
Why should clinicians adhere to M.E.A.T. guidelines?
To put it plainly: audits are coming, and accurate clinical documentation is the best defense against financial penalties. If a note says “diabetes” but doesn’t show how it was evaluated, addressed, or treated, it may not meet CMS standards – even if the provider managed it properly.
Inaccurate or nonspecific clinical documentation puts an organization at risk for revenue loss, which trickles down to the health plan and increases administrative burdens through queries and retroactive reviews.
What’s at risk if clinicians don’t incorporate M.E.A.T. criteria?
Failure to comply with M.E.A.T. guidelines can result in several unwanted consequences, including:
- Increased administrative burden: Vague or incorrect documentation increases the risk of clinical documentation improvement (CDI) queries, retroactive reviews, and compliance intervention
Clawbacks: Medicare Advantage Organizations (MAOs) can ask providers to repay funds for services when the diagnosis codes used for risk adjustment are later deemed unsupported by CMS
Contract renegotiations: MAOs might tighten contract terms, strengthen clawback provisions, and demand greater accountability for documentation accuracy
Future income and network risk: Repeated documentation issues or large recoupments can compel MAOs to reduce future payments to providers in contract renegotiations, or in extreme cases, exclude them from MAO networks altogether
Complete documentation protects a health system’s patients, revenue, and reputation.
What does M.E.A.T.-compliant clinical documentation look like?
Imagine a patient schedules a visit for joint pain but also mentions having diabetes and hypertension. Complete documentation for this encounter would resemble the following: “BP 138/82, stable on Lisinopril. Patient adherent to meds. A1c due next visit. Continue current regimen.”
It’s really that simple. Plus, if a condition isn’t managed the same day, that’s fine too. Only document what’s relevant. When addressing the condition, just ensure it’s reflected in the note.
How to ensure clinicians follow M.E.A.T. criteria
Even when the rationale and importance of the M.E.A.T. framework is understood, it can be challenging to ensure physicians follow it consistently. This is where partnering with an experienced vendor, like IMO Health, comes in.
IMO Health’s point of care solutions are designed to streamline clinician workflows – not disrupt them. Our tooling allows providers to document in their preferred clinical language, while automatically capturing the necessary codes and specificity behind the scenes. To support M.E.A.T. compliance, IMO Health:
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Flags lapsed acute HCCs to help manage evolving chronic conditions that can only be coded within a specific timeframe after onset (e.g., stroke, sepsis), reducing audit risk due to upcoding
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Prevents upcoding by offering compliant, audit-ready alternatives that support continued monitoring – without risking overpayment
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Links problems to relevant medications and labs within the electronic health record (EHR), eliminating siloed data searches and streamlining documentation
M.E.A.T. is the key to defensible, efficient clinical documentation
Accurate documentation is the foundation of effective risk adjustment. When chronic and complex conditions are clearly captured using M.E.A.T. criteria, payers, auditors, and care teams align to produce a complete picture of patient acuity.
Increased audit activity has raised the bar for clinical documentation. A M.E.A.T.-driven approach aligns payers, auditors, and care teams to produce a complete picture of patient acuity. Furthermore, it ensures that conditions are not only coded correctly but are supported with the clinical evidence required for risk adjustment. This enhances data integrity, safeguards reimbursement, and strengthens care delivery across the healthcare continuum.
