News: OIG to publish report on costs associated with current CMS, CDC sepsis definition

According to the Office of Inspector General (OIG) Work Plan, the agency plans to publish a report in 2025 on the costs to Medicare associated with CMS and CDC using the current broader definition of sepsis for billing purposes (i.e., Sepsis-2).

“Sepsis is a frequently billed diagnosis in Medicare. There are concerns that hospitals may be taking advantage of this broader definition, as they have a financial incentive to do so,” according to the OIG. “This study will analyze Medicare claims to assess patterns in the inpatient hospital billing of sepsis in 2023 and describe how the billing of sepsis varied among hospitals.”

A previous OIG study published in 2021 already found that there is a trend of inpatient stays becoming more expensive. One finding in particular was that the most frequently billed MS-DRG in fiscal year 2019 was sepsis or severe sepsis with a major complication (MS-DRG 871), for which hospitals billed 581,00 of these stays and Medicare paid $7.4 billion, JustCoding reported.

The OIG report on sepsis billing and associated costs will publish sometime in 2025, but the agency has not announced an exact publication date yet.

Editor’s note: To read the OIG Work Plan update regarding the upcoming sepsis study/report, click here. To read JustCoding’s coverage and recommendations around sepsis billing, click here.