COVID-19: Uphold ICD-10-CM reporting, MS-DRG assignment to manage denials, reimbursement

Why This Topic Matters

The article is relevant to organizations managing COVID-19 inpatient billing risk, payer scrutiny, and the need to support accurate clinical data while protecting revenue.

Article Sections

1. CMS audits return

   Discusses the resumption of CMS review activity and the broader operational implications for organizations preparing for audits. It also references recently approved RAC topics and staffing considerations.

2. Current denial landscape

   Reviews common denial pressure points during the pandemic and the types of inpatient claims that may draw payer attention. It also addresses how case complexity can affect DRG assignment.

3. Accurately reporting severity

   Focuses on documentation, query processes, and front-end review practices used to better capture severity of illness. It also discusses collaboration among CDI, physicians, and coders.

4. Second wave

   Covers readmission considerations for patients after COVID-19 and the importance of documenting subsequent conditions and related history. It emphasizes the longer-term data value of complete records.