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Audit (A-03-13-00036)

05-06-2014
Morristown Medical Center Incorrectly Billed Medicare Inpatient Claims With Kwashiorkor

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Summary

Morristown Medical Center, in Morristown, New Jersey (the Hospital), did not comply with Medicare requirements for billing Kwashiorkor on 197 of the 198 claims that we reviewed. The Hospital used diagnosis code 260 for Kwashiorkor but should have used codes for other forms of malnutrition. The remaining claim had a physician's diagnosis of Kwashiorkor and therefore was billed correctly. For 149 of the incorrectly billed inpatient claims, correcting the diagnosis code resulted in no change in the payment. However, for the remaining 48 inpatient claims, the errors resulted in overpayments of $374,603. Hospital officials attributed these errors to a lack of clarity in the coding guidelines and issues with the medical coding software program used to code the diagnoses.

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