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News: OIG sites Nebraska hospital for billing errors

CDI Strategies, January 7, 2016

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For calendar years (CYs) 2012 and 2013, Medicare overpaid Nebraska Methodist Hospital in Omaha more than $111,000 for 19 inpatient and outpatient claims, including insufficiently documented sepsis and septic syndrome.

After examining 138 claims in a Medicare Compliance Review, Medicare found that 17 inpatient claims and two outpatient claims had billing errors, resulting in overpayments of $86,494 and $24,622, respectively, according to a recent OIG report. Errors included insufficiently documented diagnosis codes, outpatient claims incorrectly billed as inpatient, and same-day discharges and readmissions.

Medicare ordered the hospital to refund $111,116 to the organization. Methodist Health System has submitted corrected claims to Medicare for payment adjustment.

In a written response to the review, Kimberly A. Lammers, JD, CPC, vice president of compliance at Methodist Health System, the hospital has taken a number of actions to prevent future billing errors. These include:

• Hiring a fulltime ICD-9/ICD-10 trainer, responsible for training new coding staff and providing education.
• Ensuring coders collaborate with clinical documentation specials to assist in the interpretation of clinical documentation, query physicians for additional documentation when necessary, and conduct ongoing physician education.
• Scheduling continued ICD-10 diagnosis and procedure training.
• Contracting with an external auditor to perform DRG validation audits semi-annually.

The hospital shared the results of this audit with the inpatient coders and clinical documentation specialists, and will provide specific training on sepsis and septic syndrome based on the problem areas identified through the Medicare review, Lammers says.

Many hospitals struggle with sepsis documentation, says Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, FCS, PCS, CCDS, C-CDI, director of enterprise solutions for ZirMed in Louisville, Kentucky,. “which is not surprising. Sepsis is over-documented and over-coded.”

CDI professionals can help ensure that physician documentation accurately reflects appropriate documentation, and work with physicians and coders to prevent inappropriate sepsis-related code assignment.

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