User Manual Q&AAnswer
Mar 13, 2025 - 01:34 AM
To contribute to the risk adjustment model for SCFHP, it is important to accurately and completely document your patients' diagnoses in their medical records and report the same information on the claim submission. Here are some specific steps you can take:
1. See your patients at least once a year for a face-to-face visit: It is important to have regular visits with your patients to assess their health conditions and update their diagnoses.
2. Use the "MEAT" criteria when documenting: Make sure each diagnosis has at least one element of "MEAT" - Managed, Evaluated, Assessed, or Treated. This means documenting signs and symptoms, test results, medication effectiveness, referrals, decision making, and treatment plans related to each diagnosis.
3. Be specific when documenting: Use terms such as "acute" and "chronic" when applicable, link medications to diagnoses, and code all conditions that are active and affect patient care. This level of specificity helps ensure accurate risk adjustment coding.
4. Capture all acute and chronic diagnoses: Submit all acute and chronic diagnoses assessed or addressed during the visit through claims. This includes documenting and coding for conditions such as vascular disease, morbid obesity, pulmonary diseases, diabetes with chronic complications, congestive heart failure, mental health disorders, arthritis and inflammatory connective tissue disease, cancer and leukemia, drug and alcohol dependence, coagulation defects, chronic ulcers, and amputations.
By following these practices, you can contribute to the risk adjustment model and help ensure that SCFHP receives sufficient funding to cover the risk and level of care that their members need.
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