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Medicare Claims on Which Hospitals Billed for Severe Malnutrition

Many elderly Medicare patients, especially those who are severely ill, are malnourished. Malnutrition can result from such things as the treatment of another condition, inadequate treatment or neglect, or the general deterioration of a patient's health. Hospitals are allowed to bill for the treatment of malnutrition on the basis of the severity of the condition -- mild, moderate or severe, and whether it affects patient care. This review would assess the accuracy of Medicare payments for the treatment of severe malnutrition. Severe malnutrition is classified as a major complication or comorbidity (MCC). Adding an MCC to a Medicare claim can result in a higher Medicare payment because the claim is coded at a higher Diagnosis Related Group. Our objective is to determine whether providers are complying with Medicare billing requirements when assigning diagnosis codes for the treatment of severe types of malnutrition on inpatient hospital claims.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
November 2017 Centers for Medicare & Medicaid Services Medicare Claims on Which Hospitals Billed for Severe Malnutrition Office of Audit Services W-00-17-35804 2018

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