COVID-19 DRG with Enhanced Payments to be Audited


As part of the public health emergency CMS added increased weighted reimbursement to COVID-19 DRGs.  With a quick decline in revenue and uncertainty of how to code for COVID-19 cases there was a period of time of confusion.  The increased payment brought pressure on coders to assign COVID-19 diagnosis as principle diagnosis when in actuality it may not have been.  We have advised clients to follow correct coding guidelines.  Many coders faced challenges of business leaders to capture the increased payment.

It comes with no surprise CMS will be auditing inpatient discharges with COVID-19 diagnosis impacting the DRG for enhanced payment.  Hopefully the contractors have experienced coders and quality review process before issuing overpayment demands to hospitals.

This will increase the the requests for medical records along with new Recovery Audit Contractor audit areas recently approved early in the month.  Organizations need to be vigilant in responding to record requests timely and provide exactly what is requested.  Carefully review any overpayment demand letters and confirm all findings before accepting an overpayment.  Validation of payor findings can be conducted by internal resources or by contacting a third-party to conduct reviews and challenge overpayments.  The cost of third-party reviews are often affordable and worth every penny.