News: DRG issues in the eye of the OIG

In its 2016–2017 Work Plan, (read the related CDI Strategies article on the topic) the Office of the Inspector General (OIG) responsible for Medicare billing and reimbursement integrity called out DRGs in two specific areas—kwashiorkor and mechanical ventilation—for additional scrutiny, Elizabeth S. Goar reports in a recent For The Record article.

To combat such targets, pay attention to outdate templates capturing mechanical ventilation and to electronic health record system logic related to malnutrition, Goar writes.

In fact, in a December 2016 report, the OIG nabbed yet another medical center—Northside Medical Center of ValleyCare Health System in Ohio—for receiving roughly a million in overpayments out of a possible $11,076,498 in Medicare payments for 699 inpatient hospital claims that included a diagnosis code for a severe type of malnutrition from January 1, 2013, through June 30, 2015, according to an agency report. Northside disagreed with the OIG’s findings.