The OIG has updated its Work Plan to include Medicare claims in which hospitals billed for severe malnutrition. Malnutrition is coded on the claim based on the degree of severity – mild, moderate or severe. If the diagnosis of severe malnutrition is reported on the claim, it is classified as a major complication and/or comorbidity (MCC) and results in a higher Medicare payment based on a higher DRG that is assigned. The OIG will look at whether providers are complying with Medicare billing requirements when assigning diagnosis codes for malnutrition on inpatient hospital claims.
Additional information regarding the work plan is available at: https://oig.hhs.gov/reports-and-publications/workplan/updates.asp
We recommend providers review the Work Plan updates monthly and conduct proactive audits of the applicable areas identified in the Work Plan.