Understanding MEAT Criteria Coding: The Four Letters That Determine Your Audit Success

You’ve probably heard the acronym a thousand times. MEAT: Monitor, Evaluate, Assess, and Treat. It sounds simple until you’re doing actual MEAT criteria coding and staring at a medical chart trying to figure out if the documentation actually meets CMS requirements.

The challenge isn’t understanding what MEAT means. The challenge is applying MEAT criteria coding consistently across thousands of charts, dozens of providers, and hundreds of different documentation styles. Because when a RADV audit happens, CMS doesn’t care about your good intentions. They care about whether the documentation proves the condition was actively managed.

Why MEAT Criteria Coding Exists

CMS created MEAT criteria coding for a specific reason: to prevent health plans from claiming risk adjustment payments for conditions that aren’t actually affecting patient care. It’s not enough to document that a patient has diabetes. CMS wants to know: did the provider actually address that diabetes during this encounter?

That’s a reasonable standard. If a patient comes in for an ankle injury and the provider writes “history of diabetes” in the problem list but never mentions it again, should that encounter support a diabetes HCC? Under MEAT criteria coding rules, CMS says no, and they’re right.

But here’s where it gets complicated. Real clinical documentation is messy. Providers don’t always spell things out perfectly. A note might say “continue metformin” without explicitly stating it’s for diabetes management. Does that meet MEAT criteria coding standards? What about “A1C checked last month, stable”? Is that monitoring, evaluating, or both?

These aren’t hypothetical questions. These are the exact scenarios that cause coding rejections during audits.

What Each MEAT Component Actually Means

Let’s break down what CMS is really looking for with each element of MEAT criteria coding.

“Monitor” means the provider documented they’re tracking the condition over time. This could be reviewing test results, checking vital signs, or noting symptom progression. The key word is “checking.” If the note says “blood pressure 140/90,” that’s data. If it says “blood pressure remains elevated at 140/90,” that’s monitoring and supports MEAT criteria coding.

“Evaluate” means the provider assessed how the condition is affecting the patient. This goes beyond just noting the condition exists. It includes statements about severity, control status, or comparison to previous encounters. “Diabetes poorly controlled” meets MEAT criteria coding standards. “Diabetes” by itself doesn’t.

“Assess” is where many organizations struggle with MEAT criteria coding. Some people think assessment and evaluation mean the same thing. CMS distinguishes them, though the line can blur. Assessment typically refers to the provider’s clinical judgment about the condition’s status or impact on the patient’s overall health. Think: “Diabetic nephropathy appears to be progressing” or “COPD stable, no exacerbation.”

“Treat” means the provider documented active management. This includes prescribing medications, ordering tests, making referrals, or providing patient education. The critical part for MEAT criteria coding is showing the treatment connects to the specific condition. “Refill all medications” is vague. “Increase lisinopril to 20mg for blood pressure control” is specific.

The Common MEAT Criteria Coding Failures

After reviewing thousands of audited charts, the patterns are predictable. Here’s what typically fails MEAT criteria coding requirements:

Old diagnoses treated as current without evidence. A provider copies forward last year’s problem list, including “history of DVT” or “past stroke,” without documenting any current monitoring or treatment. CMS rejects these instantly during MEAT criteria coding review. Historical conditions need active management to be coded.

Vague language without clinical context. Phrases like “stable,” “chronic,” or “no change” appear everywhere, but they don’t prove the provider actually addressed the condition. You need to know what’s stable, how the provider knows it’s stable, and what they’re doing to keep it stable.

Missing the treatment connection. The chart shows a patient is on multiple medications, but it doesn’t explicitly link them to specific conditions. “Continue current regimen” fails MEAT criteria coding unless the note somewhere identifies what each medication treats and why.

Laboratory results without interpretation. Test results alone don’t meet MEAT criteria coding standards. If the note shows “HbA1c 8.2%” but never mentions what the provider did with that information, it’s just data. You need “HbA1c 8.2%, will increase metformin dose.”

How to Improve MEAT Criteria Coding Compliance

The fix isn’t asking providers to write novels in every chart. It’s about teaching them to document intentionally for MEAT criteria coding.

Start with templates and prompts. EHR systems can guide providers toward MEAT criteria coding compliance without adding significant time burden. When a provider selects a diagnosis, the template should prompt: “How are you managing this condition today?”

Create provider feedback loops. When a coder can’t find MEAT criteria coding support, query the provider immediately, not three months later. Real-time feedback helps providers learn what documentation works and what doesn’t.

Use concrete examples from actual audits. Abstract explanations of MEAT criteria coding don’t stick. Show providers real examples from your own charts: “Here’s a note that passed CMS audit. Here’s one that failed. Notice the difference?”

The Query Process Matters

When documentation is unclear for MEAT criteria coding purposes, coders need to query providers. But the quality of that query makes all the difference.

Bad queries are vague: “Please provide additional documentation for diabetes.” That tells the provider nothing about what’s missing from a MEAT criteria coding perspective.

Good queries are specific: “The encounter note documents metformin 1000mg, but doesn’t specify if this is continued therapy or a dosage change. Please clarify the treatment rationale to meet MEAT criteria coding requirements.”

The goal isn’t to create documentation that wasn’t there. It’s to clarify documentation that exists but wasn’t clearly stated. There’s a big difference, and CMS knows it.

Final Thoughts

MEAT criteria coding requirements aren’t going away. If anything, CMS is getting stricter about enforcement as their audit technology improves. The plans that succeed are the ones treating MEAT criteria coding compliance as an everyday operational discipline, not an audit preparation task.