Northside Medical Center Incorrectly Billed Medicare Inpatient Claims with Severe Malnutrition

“Northside Medical Center (The Hospital), in Youngstown, Ohio complied with Medicare billing requirements for diagnosis codes 261 and 262 for 2 of the 100 claims that were reviewed,” according to an audit conducted by the Office of Inspector General. However, the Hospital did not comply with Medicare billing requirements for the remaining 98 claims.

For two of these claims, the medical record documentation supported a secondary diagnosis code other than 261 or 262, but the error resulted in no change to the diagnosis-related group or payment. For the remaining 96 claims, the billing errors resulted in overpayments of $464,000.

These errors occurred because the Hospital used diagnosis code 261 or 262 when it should have used codes for other forms of malnutrition or no malnutrition diagnosis code at all. On the basis of our sample results, we estimated that the Hospital received overpayments of at least $1.28 million over 2 and a half years.

Copies can also be obtained by contacting the Office of Public Affairs at Public.Affairs@oig.hhs.gov.

Download the complete report.
Learn more about how Verisys can assist your HCOs in meeting all government and regulatory standards.

Written by Verisys Verisys transforms provider data, workforce data, and relationship management. Healthcare, life science, and background screening organizations rely on our comprehensive solutions to discover their true potential. Visit verisys.com to learn how we turn problems into power. Secure, configurable, and proven solutions Accurate, compliant, and complete information NCQA, URAC, and ISO accreditations/certifications Follow us on LinkedIn