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Hospitals Billing for Severe Malnutrition on Medicare Claims

Many elderly Medicare patients, especially those who are severely ill, are malnourished. Malnutrition can result from the treatment of another condition, inadequate treatment or neglect, or the general deterioration of a patient's health. Medicare sets forth a number of Federal requirements, including the Social Security Act § 1862(a)(1)(A), related to billing for the treatment of severe malnutrition. 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. 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. This review will assess the accuracy of Medicare payments for the treatment of severe malnutrition. We will 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)
Completed (partial) Centers for Medicare & Medicaid Services Hospitals Billing for Severe Malnutrition on Medicare Claims Office of Audit Services A-03-17-00005; W-00-17-35804 2019

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