Re: Finally!!!! Medicare fraud ????

[Guest guest]

Possible they are coding this dx based only on serum albumin (which we all know

is NOT a good indication of protein status & so much more likely to be decreased

in hospitalized patients if they have acute infectious process).

Holly

 ----------

Holly Lee Brewer, MS RD CDE

Pediatric Dietitian, Diabetes Educator

Medical Nutrition Therapist, Las Vegas, NV

Maj Holly Brewer, USAFR BSC http://hollyinbalad.blogspot.com

301st MDS, NAS JRB Fort Worth (Carswell), TX

Joint Base Balad, Iraq (Jan-Jul 2009)

________________________________

To: rd-usa

Sent: Tue, March 1, 2011 12:53:42 PM

Subject: Finally!!!! Medicare fraud ????

 

http://www.sacbee.com/2011/02/20/v-print/3414850/medicare-billed-for-exotic-illn\

ess.html

Tina Marie

[Guest guest]

The codes come from the Doctors; however, these hospitals pressure

docs to do procedures and Dx codes for best insurance reimbursement.

Most hospitals are always trying to stay one step ahead of Medicare!

Most are smart enough to document Dx codes and do not want to be

involved in fraud. I hope they have Nutrition Support RDs and a good

Medical Nutrition committee and QA committee. Most hospital's have

mostly malnourished critically ill patients that are what us older RDs

would call ICU status. I hope ADA and other RDs write and Blog about

this story. I hope it brings attention to the malnourished patients

coming from nursing homes and elderly homes that do not have adequate

medical nutrition regulations and care by RDs.

Sent from my iPhone

> Possible they are coding this dx based only on serum albumin (which

> we all know

> is NOT a good indication of protein status & so much more likely to

> be decreased

> in hospitalized patients if they have acute infectious process).

>

> Holly

>

> ----------

> Holly Lee Brewer, MS RD CDE

> Pediatric Dietitian, Diabetes Educator

> Medical Nutrition Therapist, Las Vegas, NV

>

> Maj Holly Brewer, USAFR BSC http://hollyinbalad.blogspot.com

> 301st MDS, NAS JRB Fort Worth (Carswell), TX

> Joint Base Balad, Iraq (Jan-Jul 2009)

>

> ________________________________

>

> To: rd-usa

> Sent: Tue, March 1, 2011 12:53:42 PM

> Subject: Finally!!!! Medicare fraud ????

>

>

>

http://www.sacbee.com/2011/02/20/v-print/3414850/medicare-billed-for-exotic-illn\

ess.html

>

> Tina Marie

>

>

[Guest guest]

I thought we'd discussed this last week.

The codes do not come from the MD. In most cases, while the provider

is very aware of the ICD-9-CM term name, the code itself is not

something they'd have memorized although those in some of the

subspecialties might. Instead, in the inpatient setting, what happens

is that when a patient is discharged, the medical record goes to the

coders. The coders use software (or in the case of paper records, they

use references) that looks for particular terms that allow them to

affix an ICD code. There are various and complex rules and regulations

regarding what can be coded, how many diagnoses can be " paid " , and how

much each is paid. At the end of the day, they're looking for that

magic mix of codes that give the highest reimbursement.

As I've said before, Kwashiorkor is NOT a nutrition problem. We have

got to get past the use of albumin as a nutrition marker. We'll never

be able to prove our worth if we rely on something that has very

little to do with nutrition and hope and keep our fingers crossed that

it demonstrates the worth of the RD. I think we'd all agree that it

takes much more than a serum albumin level to diagnose malnutrition.

If you are crossing the street while eating a cheeseburger (or the

high protein food of your dreams) and you've been eating fine, doing

well, and all else is equal, have the bad luck to be hit by a bus, I

can guarantee that your albumin will be somewhere around 3.0 the next

morning. Are you malnourished? Absolutely not. Are you critically

injured? Yes. Do you need to be seen by a highly skilled, well-trained

nutrition support RD? Absolutely. But if you claim there's

malnutrition at the get go, and the albumin doesn't go up until you're

close to discharge, then you haven't demonstrated the worth of the RD.

Take a look at a paper that I published in JADA in 2004 along with

Fuhrman and Mueller; there we discuss the complexities of using

hepatic transport proteins to assess nutrition status. Also, I've

coauthored a Pocket Guide to Nutrition Assessment; we're in the second

edition and looking at a revision soon. We have an expert author

discussing use of labs. There is also a classic paper written by Gabay

that was published in the New England Journal of Medicine in 1999;

when I was teaching it was required reading for my students before

they ever got to see a sick patient. It very nicely describes the

acute phase response to illness and injury.

While technically, one could code for kwashiorkor using current ICD

definitions, remember the definition includes " dyspigmentation of the

skin and hair " . Technically, you'd also have to find somewhere in the

medical record a " severe " deficiency of protein. While I suppose one

could argue that a sick patient didn't get enough protein, do we know

how much and for how long? Do you want to be explaining this to the

CMS folks when they figure out that it is statistically impossible to

see the rate of kwashiorkor that some facilities are seeing because

someone thought it would be the best way to determine how many

patients are malnourished?

I'm all for identifying and treating malnutrition where ever it may

exist. However, I don't want to a) use the wrong tools to diagnose it

and miss it when it really does exist. Remember, serum albumin

remains normal until fairly late in starvation. Isn't that malnutrition?

Regards,

pam

Pam Charney

pcharney@...

> The codes come from the Doctors; however, these hospitals pressure

> docs to do procedures and Dx codes for best insurance reimbursement.

> Most hospitals are always trying to stay one step ahead of Medicare!

> Most are smart enough to document Dx codes and do not want to be

> involved in fraud. I hope they have Nutrition Support RDs and a good

> Medical Nutrition committee and QA committee. Most hospital's have

> mostly malnourished critically ill patients that are what us older RDs

> would call ICU status. I hope ADA and other RDs write and Blog about

> this story. I hope it brings attention to the malnourished patients

> coming from nursing homes and elderly homes that do not have adequate

> medical nutrition regulations and care by RDs.

>

> Sent from my iPhone

>

>

>

> > Possible they are coding this dx based only on serum albumin (which

> > we all know

> > is NOT a good indication of protein status & so much more likely to

> > be decreased

> > in hospitalized patients if they have acute infectious process).

> >

> > Holly

> >

> > ----------

> > Holly Lee Brewer, MS RD CDE

> > Pediatric Dietitian, Diabetes Educator

> > Medical Nutrition Therapist, Las Vegas, NV

> >

> > Maj Holly Brewer, USAFR BSC http://hollyinbalad.blogspot.com

> > 301st MDS, NAS JRB Fort Worth (Carswell), TX

> > Joint Base Balad, Iraq (Jan-Jul 2009)

> >

> > ________________________________

> >

> > To: rd-usa

> > Sent: Tue, March 1, 2011 12:53:42 PM

> > Subject: Finally!!!! Medicare fraud ????

> >

> >

> >

http://www.sacbee.com/2011/02/20/v-print/3414850/medicare-billed-for-exotic-illn\

ess.html

> >

> > Tina Marie

> >

> >

[Guest guest]

I thought we'd discussed this last week.

The codes do not come from the MD. In most cases, while the provider

is very aware of the ICD-9-CM term name, the code itself is not

something they'd have memorized although those in some of the

subspecialties might. Instead, in the inpatient setting, what happens

is that when a patient is discharged, the medical record goes to the

coders. The coders use software (or in the case of paper records, they

use references) that looks for particular terms that allow them to

affix an ICD code. There are various and complex rules and regulations

regarding what can be coded, how many diagnoses can be " paid " , and how

much each is paid. At the end of the day, they're looking for that

magic mix of codes that give the highest reimbursement.

As I've said before, Kwashiorkor is NOT a nutrition problem. We have

got to get past the use of albumin as a nutrition marker. We'll never

be able to prove our worth if we rely on something that has very

little to do with nutrition and hope and keep our fingers crossed that

it demonstrates the worth of the RD. I think we'd all agree that it

takes much more than a serum albumin level to diagnose malnutrition.

If you are crossing the street while eating a cheeseburger (or the

high protein food of your dreams) and you've been eating fine, doing

well, and all else is equal, have the bad luck to be hit by a bus, I

can guarantee that your albumin will be somewhere around 3.0 the next

morning. Are you malnourished? Absolutely not. Are you critically

injured? Yes. Do you need to be seen by a highly skilled, well-trained

nutrition support RD? Absolutely. But if you claim there's

malnutrition at the get go, and the albumin doesn't go up until you're

close to discharge, then you haven't demonstrated the worth of the RD.

Take a look at a paper that I published in JADA in 2004 along with

Fuhrman and Mueller; there we discuss the complexities of using

hepatic transport proteins to assess nutrition status. Also, I've

coauthored a Pocket Guide to Nutrition Assessment; we're in the second

edition and looking at a revision soon. We have an expert author

discussing use of labs. There is also a classic paper written by Gabay

that was published in the New England Journal of Medicine in 1999;

when I was teaching it was required reading for my students before

they ever got to see a sick patient. It very nicely describes the

acute phase response to illness and injury.

While technically, one could code for kwashiorkor using current ICD

definitions, remember the definition includes " dyspigmentation of the

skin and hair " . Technically, you'd also have to find somewhere in the

medical record a " severe " deficiency of protein. While I suppose one

could argue that a sick patient didn't get enough protein, do we know

how much and for how long? Do you want to be explaining this to the

CMS folks when they figure out that it is statistically impossible to

see the rate of kwashiorkor that some facilities are seeing because

someone thought it would be the best way to determine how many

patients are malnourished?

I'm all for identifying and treating malnutrition where ever it may

exist. However, I don't want to a) use the wrong tools to diagnose it

and miss it when it really does exist. Remember, serum albumin

remains normal until fairly late in starvation. Isn't that malnutrition?

Regards,

pam

Pam Charney

pcharney@...

> The codes come from the Doctors; however, these hospitals pressure

> docs to do procedures and Dx codes for best insurance reimbursement.

> Most hospitals are always trying to stay one step ahead of Medicare!

> Most are smart enough to document Dx codes and do not want to be

> involved in fraud. I hope they have Nutrition Support RDs and a good

> Medical Nutrition committee and QA committee. Most hospital's have

> mostly malnourished critically ill patients that are what us older RDs

> would call ICU status. I hope ADA and other RDs write and Blog about

> this story. I hope it brings attention to the malnourished patients

> coming from nursing homes and elderly homes that do not have adequate

> medical nutrition regulations and care by RDs.

>

> Sent from my iPhone

>

>

>

> > Possible they are coding this dx based only on serum albumin (which

> > we all know

> > is NOT a good indication of protein status & so much more likely to

> > be decreased

> > in hospitalized patients if they have acute infectious process).

> >

> > Holly

> >

> > ----------

> > Holly Lee Brewer, MS RD CDE

> > Pediatric Dietitian, Diabetes Educator

> > Medical Nutrition Therapist, Las Vegas, NV

> >

> > Maj Holly Brewer, USAFR BSC http://hollyinbalad.blogspot.com

> > 301st MDS, NAS JRB Fort Worth (Carswell), TX

> > Joint Base Balad, Iraq (Jan-Jul 2009)

> >

> > ________________________________

> >

> > To: rd-usa

> > Sent: Tue, March 1, 2011 12:53:42 PM

> > Subject: Finally!!!! Medicare fraud ????

> >

> >

> >

http://www.sacbee.com/2011/02/20/v-print/3414850/medicare-billed-for-exotic-illn\

ess.html

> >

> > Tina Marie

> >

> >

[Guest guest]

Yes, the Dx comes from doc and many go to coders now! Kwashiorkor may

not have been the best code for the coders to use but I do not think

they were being fraudulent! There is plenty of malnutrition any way

you code it:)

Sent from my iPhone

> I thought we'd discussed this last week.

>

> The codes do not come from the MD. In most cases, while the provider

> is very aware of the ICD-9-CM term name, the code itself is not

> something they'd have memorized although those in some of the

> subspecialties might. Instead, in the inpatient setting, what happens

> is that when a patient is discharged, the medical record goes to the

> coders. The coders use software (or in the case of paper records, they

> use references) that looks for particular terms that allow them to

> affix an ICD code. There are various and complex rules and regulations

> regarding what can be coded, how many diagnoses can be " paid " , and how

> much each is paid. At the end of the day, they're looking for that

> magic mix of codes that give the highest reimbursement.

>

> As I've said before, Kwashiorkor is NOT a nutrition problem. We have

> got to get past the use of albumin as a nutrition marker. We'll never

> be able to prove our worth if we rely on something that has very

> little to do with nutrition and hope and keep our fingers crossed that

> it demonstrates the worth of the RD. I think we'd all agree that it

> takes much more than a serum albumin level to diagnose malnutrition.

> If you are crossing the street while eating a cheeseburger (or the

> high protein food of your dreams) and you've been eating fine, doing

> well, and all else is equal, have the bad luck to be hit by a bus, I

> can guarantee that your albumin will be somewhere around 3.0 the next

> morning. Are you malnourished? Absolutely not. Are you critically

> injured? Yes. Do you need to be seen by a highly skilled, well-trained

> nutrition support RD? Absolutely. But if you claim there's

> malnutrition at the get go, and the albumin doesn't go up until you're

> close to discharge, then you haven't demonstrated the worth of the RD.

>

> Take a look at a paper that I published in JADA in 2004 along with

> Fuhrman and Mueller; there we discuss the complexities of using

> hepatic transport proteins to assess nutrition status. Also, I've

> coauthored a Pocket Guide to Nutrition Assessment; we're in the second

> edition and looking at a revision soon. We have an expert author

> discussing use of labs. There is also a classic paper written by Gabay

> that was published in the New England Journal of Medicine in 1999;

> when I was teaching it was required reading for my students before

> they ever got to see a sick patient. It very nicely describes the

> acute phase response to illness and injury.

>

> While technically, one could code for kwashiorkor using current ICD

> definitions, remember the definition includes " dyspigmentation of the

> skin and hair " . Technically, you'd also have to find somewhere in the

> medical record a " severe " deficiency of protein. While I suppose one

> could argue that a sick patient didn't get enough protein, do we know

> how much and for how long? Do you want to be explaining this to the

> CMS folks when they figure out that it is statistically impossible to

> see the rate of kwashiorkor that some facilities are seeing because

> someone thought it would be the best way to determine how many

> patients are malnourished?

>

> I'm all for identifying and treating malnutrition where ever it may

> exist. However, I don't want to a) use the wrong tools to diagnose it

> and miss it when it really does exist. Remember, serum albumin

> remains normal until fairly late in starvation. Isn't that

> malnutrition?

>

> Regards,

> pam

>

> Pam Charney

> pcharney@...

>

>

>

>

>

>> The codes come from the Doctors; however, these hospitals pressure

>> docs to do procedures and Dx codes for best insurance reimbursement.

>> Most hospitals are always trying to stay one step ahead of Medicare!

>> Most are smart enough to document Dx codes and do not want to be

>> involved in fraud. I hope they have Nutrition Support RDs and a good

>> Medical Nutrition committee and QA committee. Most hospital's have

>> mostly malnourished critically ill patients that are what us older

>> RDs

>> would call ICU status. I hope ADA and other RDs write and Blog about

>> this story. I hope it brings attention to the malnourished patients

>> coming from nursing homes and elderly homes that do not have adequate

>> medical nutrition regulations and care by RDs.

>>

>> Sent from my iPhone

>>

>>

>>

>>> Possible they are coding this dx based only on serum albumin (which

>>> we all know

>>> is NOT a good indication of protein status & so much more likely to

>>> be decreased

>>> in hospitalized patients if they have acute infectious process).

>>>

>>> Holly

>>>

>>> ----------

>>> Holly Lee Brewer, MS RD CDE

>>> Pediatric Dietitian, Diabetes Educator

>>> Medical Nutrition Therapist, Las Vegas, NV

>>>

>>> Maj Holly Brewer, USAFR BSC http://hollyinbalad.blogspot.com

>>> 301st MDS, NAS JRB Fort Worth (Carswell), TX

>>> Joint Base Balad, Iraq (Jan-Jul 2009)

>>>

>>> ________________________________

>>>

>>> To: rd-usa

>>> Sent: Tue, March 1, 2011 12:53:42 PM

>>> Subject: Finally!!!! Medicare fraud ????

>>>

>>>

>>>

http://www.sacbee.com/2011/02/20/v-print/3414850/medicare-billed-for-exotic-illn\

ess.html

>>>

>>> Tina Marie

>>>

>>>

[Guest guest]

Yes, the Dx comes from doc and many go to coders now! Kwashiorkor may

not have been the best code for the coders to use but I do not think

they were being fraudulent! There is plenty of malnutrition any way

you code it:)

Sent from my iPhone

> I thought we'd discussed this last week.

>

> The codes do not come from the MD. In most cases, while the provider

> is very aware of the ICD-9-CM term name, the code itself is not

> something they'd have memorized although those in some of the

> subspecialties might. Instead, in the inpatient setting, what happens

> is that when a patient is discharged, the medical record goes to the

> coders. The coders use software (or in the case of paper records, they

> use references) that looks for particular terms that allow them to

> affix an ICD code. There are various and complex rules and regulations

> regarding what can be coded, how many diagnoses can be " paid " , and how

> much each is paid. At the end of the day, they're looking for that

> magic mix of codes that give the highest reimbursement.

>

> As I've said before, Kwashiorkor is NOT a nutrition problem. We have

> got to get past the use of albumin as a nutrition marker. We'll never

> be able to prove our worth if we rely on something that has very

> little to do with nutrition and hope and keep our fingers crossed that

> it demonstrates the worth of the RD. I think we'd all agree that it

> takes much more than a serum albumin level to diagnose malnutrition.

> If you are crossing the street while eating a cheeseburger (or the

> high protein food of your dreams) and you've been eating fine, doing

> well, and all else is equal, have the bad luck to be hit by a bus, I

> can guarantee that your albumin will be somewhere around 3.0 the next

> morning. Are you malnourished? Absolutely not. Are you critically

> injured? Yes. Do you need to be seen by a highly skilled, well-trained

> nutrition support RD? Absolutely. But if you claim there's

> malnutrition at the get go, and the albumin doesn't go up until you're

> close to discharge, then you haven't demonstrated the worth of the RD.

>

> Take a look at a paper that I published in JADA in 2004 along with

> Fuhrman and Mueller; there we discuss the complexities of using

> hepatic transport proteins to assess nutrition status. Also, I've

> coauthored a Pocket Guide to Nutrition Assessment; we're in the second

> edition and looking at a revision soon. We have an expert author

> discussing use of labs. There is also a classic paper written by Gabay

> that was published in the New England Journal of Medicine in 1999;

> when I was teaching it was required reading for my students before

> they ever got to see a sick patient. It very nicely describes the

> acute phase response to illness and injury.

>

> While technically, one could code for kwashiorkor using current ICD

> definitions, remember the definition includes " dyspigmentation of the

> skin and hair " . Technically, you'd also have to find somewhere in the

> medical record a " severe " deficiency of protein. While I suppose one

> could argue that a sick patient didn't get enough protein, do we know

> how much and for how long? Do you want to be explaining this to the

> CMS folks when they figure out that it is statistically impossible to

> see the rate of kwashiorkor that some facilities are seeing because

> someone thought it would be the best way to determine how many

> patients are malnourished?

>

> I'm all for identifying and treating malnutrition where ever it may

> exist. However, I don't want to a) use the wrong tools to diagnose it

> and miss it when it really does exist. Remember, serum albumin

> remains normal until fairly late in starvation. Isn't that

> malnutrition?

>

> Regards,

> pam

>

> Pam Charney

> pcharney@...

>

>

>

>

>

>> The codes come from the Doctors; however, these hospitals pressure

>> docs to do procedures and Dx codes for best insurance reimbursement.

>> Most hospitals are always trying to stay one step ahead of Medicare!

>> Most are smart enough to document Dx codes and do not want to be

>> involved in fraud. I hope they have Nutrition Support RDs and a good

>> Medical Nutrition committee and QA committee. Most hospital's have

>> mostly malnourished critically ill patients that are what us older

>> RDs

>> would call ICU status. I hope ADA and other RDs write and Blog about

>> this story. I hope it brings attention to the malnourished patients

>> coming from nursing homes and elderly homes that do not have adequate

>> medical nutrition regulations and care by RDs.

>>

>> Sent from my iPhone

>>

>>

>>

>>> Possible they are coding this dx based only on serum albumin (which

>>> we all know

>>> is NOT a good indication of protein status & so much more likely to

>>> be decreased

>>> in hospitalized patients if they have acute infectious process).

>>>

>>> Holly

>>>

>>> ----------

>>> Holly Lee Brewer, MS RD CDE

>>> Pediatric Dietitian, Diabetes Educator

>>> Medical Nutrition Therapist, Las Vegas, NV

>>>

>>> Maj Holly Brewer, USAFR BSC http://hollyinbalad.blogspot.com

>>> 301st MDS, NAS JRB Fort Worth (Carswell), TX

>>> Joint Base Balad, Iraq (Jan-Jul 2009)

>>>

>>> ________________________________

>>>

>>> To: rd-usa

>>> Sent: Tue, March 1, 2011 12:53:42 PM

>>> Subject: Finally!!!! Medicare fraud ????

>>>

>>>

>>>

http://www.sacbee.com/2011/02/20/v-print/3414850/medicare-billed-for-exotic-illn\

ess.html

>>>

>>> Tina Marie

>>>

>>>

[Guest guest]

Well stated, Pam.

Ro

From: Weaver

Sent: Tuesday, March 01, 2011 11:52 PM

To: rd-usa

Subject: Re: Finally!!!! Medicare fraud ????

Yes, the Dx comes from doc and many go to coders now! Kwashiorkor may

not have been the best code for the coders to use but I do not think

they were being fraudulent! There is plenty of malnutrition any way

you code it:)

Sent from my iPhone

On Mar 1, 2011, at 10:50 PM, Pam Charney <mailto:pcharney%40mac.com> wrote:

> I thought we'd discussed this last week.

>

> The codes do not come from the MD. In most cases, while the provider

> is very aware of the ICD-9-CM term name, the code itself is not

> something they'd have memorized although those in some of the

> subspecialties might. Instead, in the inpatient setting, what happens

> is that when a patient is discharged, the medical record goes to the

> coders. The coders use software (or in the case of paper records, they

> use references) that looks for particular terms that allow them to

> affix an ICD code. There are various and complex rules and regulations

> regarding what can be coded, how many diagnoses can be " paid " , and how

> much each is paid. At the end of the day, they're looking for that

> magic mix of codes that give the highest reimbursement.

>

> As I've said before, Kwashiorkor is NOT a nutrition problem. We have

> got to get past the use of albumin as a nutrition marker. We'll never

> be able to prove our worth if we rely on something that has very

> little to do with nutrition and hope and keep our fingers crossed that

> it demonstrates the worth of the RD. I think we'd all agree that it

> takes much more than a serum albumin level to diagnose malnutrition.

> If you are crossing the street while eating a cheeseburger (or the

> high protein food of your dreams) and you've been eating fine, doing

> well, and all else is equal, have the bad luck to be hit by a bus, I

> can guarantee that your albumin will be somewhere around 3.0 the next

> morning. Are you malnourished? Absolutely not. Are you critically

> injured? Yes. Do you need to be seen by a highly skilled, well-trained

> nutrition support RD? Absolutely. But if you claim there's

> malnutrition at the get go, and the albumin doesn't go up until you're

> close to discharge, then you haven't demonstrated the worth of the RD.

>

> Take a look at a paper that I published in JADA in 2004 along with

> Fuhrman and Mueller; there we discuss the complexities of using

> hepatic transport proteins to assess nutrition status. Also, I've

> coauthored a Pocket Guide to Nutrition Assessment; we're in the second

> edition and looking at a revision soon. We have an expert author

> discussing use of labs. There is also a classic paper written by Gabay

> that was published in the New England Journal of Medicine in 1999;

> when I was teaching it was required reading for my students before

> they ever got to see a sick patient. It very nicely describes the

> acute phase response to illness and injury.

>

> While technically, one could code for kwashiorkor using current ICD

> definitions, remember the definition includes " dyspigmentation of the

> skin and hair " . Technically, you'd also have to find somewhere in the

> medical record a " severe " deficiency of protein. While I suppose one

> could argue that a sick patient didn't get enough protein, do we know

> how much and for how long? Do you want to be explaining this to the

> CMS folks when they figure out that it is statistically impossible to

> see the rate of kwashiorkor that some facilities are seeing because

> someone thought it would be the best way to determine how many

> patients are malnourished?

>

> I'm all for identifying and treating malnutrition where ever it may

> exist. However, I don't want to a) use the wrong tools to diagnose it

> and miss it when it really does exist. Remember, serum albumin

> remains normal until fairly late in starvation. Isn't that

> malnutrition?

>

> Regards,

> pam

>

> Pam Charney

> mailto:pcharney%40mac.com

>

>

>

>

>

>> The codes come from the Doctors; however, these hospitals pressure

>> docs to do procedures and Dx codes for best insurance reimbursement.

>> Most hospitals are always trying to stay one step ahead of Medicare!

>> Most are smart enough to document Dx codes and do not want to be

>> involved in fraud. I hope they have Nutrition Support RDs and a good

>> Medical Nutrition committee and QA committee. Most hospital's have

>> mostly malnourished critically ill patients that are what us older

>> RDs

>> would call ICU status. I hope ADA and other RDs write and Blog about

>> this story. I hope it brings attention to the malnourished patients

>> coming from nursing homes and elderly homes that do not have adequate

>> medical nutrition regulations and care by RDs.

>>

>> Sent from my iPhone

>>

>> On Mar 1, 2011, at 4:40 PM, hl brewer <mailto:hlbrewer%40yahoo.com> wrote:

>>

>>> Possible they are coding this dx based only on serum albumin (which

>>> we all know

>>> is NOT a good indication of protein status & so much more likely to

>>> be decreased

>>> in hospitalized patients if they have acute infectious process).

>>>

>>> Holly

>>>

>>> ----------

>>> Holly Lee Brewer, MS RD CDE

>>> Pediatric Dietitian, Diabetes Educator

>>> Medical Nutrition Therapist, Las Vegas, NV

>>>

>>> Maj Holly Brewer, USAFR BSC http://hollyinbalad.blogspot.com

>>> 301st MDS, NAS JRB Fort Worth (Carswell), TX

>>> Joint Base Balad, Iraq (Jan-Jul 2009)

>>>

>>> ________________________________

>>> From: Tina Marie <mailto:talk2tml%40yahoo.com>

>>> To: mailto:rd-usa%40yahoogroups.com

>>> Sent: Tue, March 1, 2011 12:53:42 PM

>>> Subject: Finally!!!! Medicare fraud ????

>>>

>>>

>>>

http://www.sacbee.com/2011/02/20/v-print/3414850/medicare-billed-for-exotic-illn\

ess.html

>>>

>>> Tina Marie

>>>

>>>