News: OIG plans to audit COVID-19 discharges

The Office of Inspector General (OIG) will begin reviewing Medicare payments for COVID-19 discharges, according to a recent update to its Work Plan.

Section 3710 of the Coronavirus Aid, Relief ,and Economic Security (CARES) Act increased the MS-DRG weighting by 20% for a COVID-19 diagnosis for the duration of the public health emergency, Revenue Cycle Advisor reported. Effective September 1, COVID-19 claims will require a positive viral test result documented in the medical record to be eligible for the 20% MS-DRG weighting increase.

According to the Work Plan, the OIG will be specifically reviewing claims to determine whether they complied with new requirements of a positive test result for the increased MS-DRG weighting.

Organizations should ensure that clinical staff, CDI specialists, coding professionals, and billing staff are aware of the new viral test result requirement. CDI specialists and coders should query for missing test results to ensure the medical record supports the diagnosis. Organizations should consider processes for holding inpatient COVID-19 claims that are pending test results and should review processes for obtaining test results from outside entities.

Editor’s note: This article originally appeared in Revenue Cycle Advisor. To read about the new testing requirement, click here. To read all of ACDIS’ coverage of the COVID-19 pandemic, click here.