News: COVID-19 inpatient stay audits begin

Earlier this summer, CMS resumed Medicare fee-for-service audits which had been suspended starting the end of March because of the COVID-19 public health emergency (PHE).

At the same time, several new topics were approved for recovery audit contractor (RAC) review, including total knee and total hip arthroplasty for medical necessity and documentation requirements, according to HealthLeaders Media.

RAC reviews for total knee and hip arthroplasty are particularly noteworthy because they are high-dollar, high-volume procedures, Dawn Crump, MA, SSBB, CHC, senior director of revenue cycle solutions for MRO Corp., told HealthLeaders. If the appropriate documentation is not present in the claim, it could be costly for hospitals.

Although government audits took a reprieve during the spring and summer due to COVID, many commercial and Medicaid audits still affected providers with many organizations “already seeing the early COVID-19 cases being audited from commercial payers,” Crump said.

Editor’s note: This story originally appeared in HealthLeaders Media. ACDIS coverage of how the OIG plans to audit COVID-19 discharges can be found here. Wondering what documentation you need to capture for effective coding and billing for COVID? Check out the ACDIS Resources section for our COVID Toolkit.