The Coronavirus pandemic has created a rise in the utilization of ventilators. Many health systems are struggling to document and code these ventilator cases properly, often resulting in significant under-billing.
CBIZ KA Consulting Services (CBIZ) has developed an assessment to assist our clients in reviewing their ventilator coding accuracy during the COVID-19 crisis. The Assessment will review overall ventilator coding accuracy and also identify Medicare cases that could be potentially re-billed to a more appropriate MS-DRG. The assessment starts from March of this year to the present and will evaluate a monthly number of cases from the MS-DRGs that we have identified as the most likely to have been improperly coded. Our staff of coding auditors will review the documentation of the selected cases to determine the appropriateness of the MS-DRG assignment.
For Medicare, the difference in reimbursement in lower vs. higher-paying MS-DRGs for ventilator cases can be tens of thousands of dollars per case. In CBIZ’s extensive history of reviewing Medicare ventilator reimbursement, we have found that far more often than not when hospitals make mistakes with ventilator coding, they usually coded to the lower-paying DRG.
The CBIZ COVID Ventilator Coding Assessment is a thorough review and evaluation of a provider’s ventilator coding and billing process. The Assessment provides written findings about coding performance, and also identifies cases that could be re-billed with a more appropriate MS-DRG. As part of the Assessment, we will present recommended action steps and provide guidance on how ventilator coding accuracy can be improved.
To provide a further in-depth look into the ventilation issue that is experienced, we invite you to read our most recent article, Mechanical Ventilation – Are You Counting Hours or Days? This article helps explore the nuances that affect coding and how our coding experts can help you navigate through these challenges. If you’re interested in reaching out to our office to discuss how our services can assist your organization, fill out the contact form to get connected.