OIG plans to audit COVID-19 discharges

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

Section 3710 of the CARES Act increased the MS-DRG weighting by 20% for a COVID-19 diagnosis for the duration of the public health emergency. 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.

The OIG will be specifically reviewing claims to determine whether they complied with requirements for the increased MS-DRG weighting. Organizations should ensure that clinical staff, CDI specialists, coders, and billing staff are aware of the new viral test result requirement. CDI specialists and coders should query for missing test results. 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.