ABSTRACT
There are many ways that healthcare facilities receive payment for services rendered. Payers can be broadly categorized as governmental payers such as Medicare and Medicaid, private payers such as insurance companies, and self-pay (paid by the patient). Payment policies promulgated through the Centers for Medicare and Medicaid Services (CMS), which administers Medicare and Medicaid, include payment methodologies for three types of facilities: inpatient (acute care), skilled nursing, and outpatient care clinics. CMS payment models are based in part on the patient’s diagnosis. As such, the proper diagnosis, documentation, and coding of the medical diagnosis of malnutrition can impact facility reimbursement rates. Many private payers create payment policies that are the same as or similar to those enacted by CMS.
