One billion dollars. That’s how much hospitals overbilled for severe malnutrition on inpatient claims during 2020, according to an Office of the Inspector General (OIG) audit. You probably know the rest of the story — ramped-up auditor scrutiny and aggressive efforts to recoup overpayments. Specifically, in late 2021 the OIG added severe malnutrition to its work plan, and audits of Medicaid claims were announced. In addition, severe malnutrition has become a target area, as a single major comorbidity or complication (MCC), on the Program for Payment Patterns Electronic Report (PEPPER).
Billing for severe malnutrition might seem like a highly risky proposition. But it doesn’t need to be this way. During this exclusive ICD10monitor webcast, Dr. Beth Wolf will clearly explain the clinical criteria for severe malnutrition, as well as CMS coding and billing requirements. Using the 2020 audit worksheets, she’ll also point out the documentation gaps that increase audit vulnerability. In addition, you’ll gain valuable insights into the addition of severe malnutrition to the PEPPER.
Why This Is Relevant:
Severe malnutrition is often under-recognized in hospital patients, yet it’s a common end-stage manifestation of other serious chronic diseases and a significant contributor to morbidity and mortality. By following Dr. Wolf’s guidance, you can improve the accuracy of your severe malnutrition diagnosis coding and fill crucial gaps in your supporting documentation. Ultimately, you’ll be better positioned to consistently capture the full, appropriate payment and reduce the threat of penalties and paybacks.
Learning Objectives:
- Understand the impact of severe malnutrition on adult hospitalized patients
- Be able to interpret OIG worksheet findings pertaining to both “correct” and “incorrect” severe malnutrition diagnosis code assignments
- Identify common gaps in the diagnosis, documentation and coding of severe malnutrition
- Learn how to deploy documentation monitoring tools to achieve accuracy and consistency
Who Should Attend
Coders, clinical documentation integrity (CDI) specialists, health information management (HIM) professionals, auditors and physician advisors.
Beth Wolf, MD, CPC, CCDS
Dr. Wolf is board certified in internal medicine, palliative medicine, and clinical informatics. For the past eight years she has worked as the Medical Director for Health Information Management with Roper St. Francis Healthcare, where she applies her expertise in clinical documentation and serves as the primary liaison to the medical staff on coding and documentation issues. Her goal is to improve data reliability and align Clinical Documentation Integrity (CDI) efforts with physician and system priorities.
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January 20, 2022 at 10:08AM
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Severe Malnutrition: Increase Coding Compliance with Clinical Validation - ICD10monitor
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