News: OIG to review Medicare inpatient hospital billing for sepsis

According to The Office of Inspector General’s (OIG) recent Work Plan March update, it will be reviewing Medicare inpatient hospital billing for sepsis.

Sepsis is diagnosis that is frequently billed in Medicare. Its multiple definitions and clinical requirements between the World Health Organization, CMS, and Centers for Disease Control and Prevention provide extra complication for CDI specialists and coders.

“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,” the Work Plan summary explains.

OIG continues to explain its concern that hospitals are taking advantage of the various sepsis definitions and criteria to receive financial incentives. It also intends to estimate the costs to Medicare associated with each definition and criteria.

Editor’s note: This article was republished from JustCoding and can be found here.