News: OIG plans to audit COVID-19 discharges
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.