New OIG Hospital Coding Study—What Does it Mean?

At the close of 2018, the Office of Inspector General (OIG) announced a coding study to be conducted on inpatient hospital billing. In 2016 hospitals billed Medicare $114 billion for inpatient hospital stays accounting for 17 percent of all Medicare payments. The purpose of the study is to identify mis or over-coding issues that involve increased reimbursements.

OIG will conduct a two-part study to assess inpatient hospital billing.

  1. Part one will analyze Medicare claims data to provide the background information. OIG will determine how inpatient hospital billing has changed over time and how inpatient billing varied among hospitals.
  2. Part two will use the results of this analysis to target certain hospitals for medical review to determine the extent to which the hospitals billed incorrect codes.
What this means for hospitals

With an expected issue date of 2020, hospitals could be targeted for review by the OIG over the next two years. Hospitals have two options. They can do nothing in hope of not being targeted or they can get ready now—it is better to be prepared. Hospitals can leverage audit and validation services to uncover coding issues before they become a bigger problem. Through data analysis, chart reviews and CDI process assessment, audit and validation solutions:

  • Evaluate the quality of physician clinical documentation for completeness, specificity, accuracy and compliance
  • Determine coding accuracy and appropriateness of code selection
  • Identify coding error trends, overpayment risk and correct coding issues

Harmony Healthcare can help. For more information on our audit and validation solutions, click here to schedule a conversation with a Harmony representative.

 

Article written by guest blogger Denise Ball. Denise has more than 20 years of healthcare coding and auditing experience and serves as Harmony Healthcare’s Senior Coding Quality Auditor.

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