Medicare AdvantageDocumentationHigh impact
Malnutrition Policy Provider Notification - Effective 10.1.2026 (PDF)
Ambetter·MO · Critical Care, Geriatrics, Internal Medicine +2 more·Claims & Billing
Effective date
Oct 15, 2026
We identified it
Aug 26, 2026
Summary
Home State Health is updating its Malnutrition Policy (CP.PP.145) effective October 15, 2026, to expand documentation requirements for inpatient malnutrition diagnoses. The policy now distinguishes between moderate (non-severe) malnutrition (ICD-10 E44.0) and severe malnutrition (ICD-10 E44.1), requiring specific physician documentation. Claims billed with malnutrition as a major complication/comorbidity (MCC) that lack proper documentation will be denied reimbursement.
Action Required
By October 15, 2026: Billing team must implement retrospective claim review processes for all inpatient claims containing ICD-10 codes E44.0 (moderate malnutrition) or E44.1 (severe malnutrition) as MCC diagnoses. Update claim submission guidelines to require providers to document malnutrition diagnosis with specific clinical details per the revised criteria. Establish denial processes for claims with malnutrition coding that lack physician documentation supporting the diagnosis severity and medical necessity. Educate hospital billing staff and provider documentation teams on the distinction between moderate and severe malnutrition coding requirements. Failure to comply will result in claim denials and potential DRG payment adjustments retroactively.