Malnutrition continues to be one of the most common audit triggers for Recovery Audit Contractors (RACs). Moreover, auditors with the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG), along with auditors for payers, consider malnutrition to be low-hanging fruit. Case in point: A hospital in Ohio had 98 of its 100 claims for malnutrition denied resulting in the recoupment of more than $1,250,000.
This same scenario could be playing out at your organization, especially with a growing population of older and frailer Medicare beneficiaries being admitted as inpatients. Now you can learn how to avoid audits and prevent denials when registering to attend this exclusive RACmonitor webcast.
And the controversy surrounding malnutrition is fertile ground for auditors. That's because some clinicians continue to believe in the highly subjective criteria to diagnose malnutrition – criteria that are decades old. Other clinicians subscribe to the American Society for Parenteral and Enteral Nutrition (ASPEN) and the Academy of Nutrition and Dietetics evidence-based diagnostic criteria. The problem: Adoption of these criteria remains low in the physician community while the probability of audits is high.
Why This is Relevant:
There are recent increases in regulatory and payer audits. Strict diagnostic and documentation guidelines can help you pass these audits with flying colors.
During this exclusive RACmonitor webcast Dr. Mahajan will…
- Discuss current regulatory and payer audit trends in malnutrition diagnosis
- Define the current diagnostic and documentation landscape as it pertains to the auditing of malnutrition by Recovery Audit Contractors (RACs);
- Discuss tradition malnutrition diagnostic criteria and its pitfalls, while comparing it to the new ASPEN criteria;
- Illustrate the importance of severe malnutrition as a major comorbid condition and its implication on relative weight, severity of illness and risk of mortality; and,
- Review strategies for CDI staff and physician leadership to optimize medical staff compliance with malnutrition diagnosis and documentation for hospitalized patients.