On July 13, 2020, the Office of the Inspector General (OIG) under the Department of Health and Human Services released a report of its findings from an audit of FY16 and FY17 hospital inpatient claims to determine whether hospitals complied with Medicare billing requirements when assigning severe malnutrition diagnosis codes. The OIG found that 173 of 200 claims reviewed did not correctly bill Medicare for severe malnutrition diagnosis codes (E41 and E43), resulting in estimated overpayments of $1 billion. The OIG recommended the Centers for Medicare & Medicaid Services (CMS) attempt to recover the overpayments.
The Academy of Nutrition and Dietetics (Academy), the American Society for Parenteral and Enteral Nutrition (ASPEN), the Association of Clinical Documentation Integrity Specialists (ACDIS), and the American Society for Nutrition (ASN) continue to be concerned about the lack of transparency around criteria used by both the OIG and CMS auditors in reviewing such claims.
Read the full statement here.