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OIG Workplan Update- COVID-19 Audits

OIG Workplan Update- COVID-19 Audits September 15, 2020

In their most recent Work Plan update, the OIG has announced they will be auditing Medicare payments for inpatient discharges billed by hospitals for beneficiaries diagnosed with COVID-19. 

Under the CARES Act, hospitals receive a 20% DRG bonus when they report a diagnosis of COVID-19 on an inpatient claim with a discharge date during the public health emergency.  

The OIG will audit will focus on inpatient claims reported with ICD-10 code B97.29 or U07.1 and will evaluate whether the diagnosis was correctly reported and supported by the medical record documentation. 

CMS released additional guidelines earlier this month indicating for dates of service on or after September 1, 2020, providers are required to have a positive COVID-19 laboratory test documented within the medical record during the admission or within 14 days prior to the admission, in order to receive the 20% bonus.

We recommend hospitals communicate these changes with their clinicians, coding and billing staff in order to ensure compliance with the reporting guidelines and to prevent overpayments. 

HBE’s team of coding and compliance experts is available to assist you with external reviews of your documentation, coding and reimbursement as well as providing customized education and training for your staff. We are also available to provide assistance with conducting risk assessments, internal investigations and policy and procedure development.

We recommend you read the Work Plan in its entirety to identify risks that are pertinent to your organization.  The Work Plan may be accessed at: 

https://oig.hhs.gov/reports-and-publications/workplan/updates.asp

Additional information regarding appropriate documentation and coding of COVID-19 may be found at: 

https://www.cms.gov/files/document/se20015.pdf

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