CMS Agrees to Work with Academy on Appropriate Identification of Malnutrition for CMS Auditors

12/07/2020 - In July 2020, the Office of the Inspector General under the Department of Health and Human Services released a report of its findings from audits to determine whether hospitals complied with Medicare billing requirements when assigning severe malnutrition diagnosis codes. In that report the OIG recommended the Centers for Medicare & Medicaid Services attempt to recover the overpayments.

Members of the multiorganizational task force including the American Society for Parenteral and Enteral Nutrition (ASPEN), the Academy of Nutrition and Dietetics, the American Society for Clinical Documentation Integrity Specialists (ACDIS) and the American Society of Nutrition (ASN) recently met with members of the CMS Provider Compliance Division expressing concerns about the lack of transparency around criteria used by auditors in reviewing severe malnutrition claims. During this meeting, the task force learned that CMS has not initiated their recovery process or "supplementary medical review" due to a pause in activities secondary to the current public health emergency.

During our discussions, CMS members outlined a plan to review the CMS Quality and Policy manuals to identify what is currently being used as criteria for both malnutrition diagnosis and treatment. In early 2021, a meeting between the Task Force and CMS will take place to review these findings and provide input as the supplemental recovery review proceeds. Further updates will be provided in 2021.

Learn more about Malnutrition Codes.