Health Information Management

News: Hospitals incorrectly billed for Kwashiorkor, hit for overpayment

CDI Strategies, October 29, 2015

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This isn’t the first time we’ve heard about hospitals billing for Kwashiorkor, a form of severe protein malnutrition typically found in third-world countries that is extremely rare in the United States.  Two hospitals— Kindred Hospital of Central Ohio in Mansfield, Ohio and Vibra Hospital of Amarillo in Amarillo, Texas—recently came under scrutiny by the OIG.

Vibra received $584,000 from Medicare for Kwashiorkor, according to this report released by the OIG. Of the 92 claims reviewed, none met requirements for Kwashiorkor, and 87 resulted in overpayment errors.

At Kindred, the OIG found that none of the 77 claims audited met requirements for Kwashiorkor. Although for 66 of the claims, substituting a more appropriate diagnosis code produced no change in payment, the remaining 11 inpatient claims errors resulted in overpayments of $62,000, according to this OIG report.

This may be an extreme example, but the lesson for CDI specialists remains the same: the information in the record must fully support the diagnosis. If it doesn’t, it’s up to the CDI specialist to query the physician for clarity or additional information to support the diagnosis.  

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