ICD10monitor December 7, 2022
Be prepared for audits of inpatient hospitalizations with explanations of attempted prevention.
The Centers for Medicare & Medicaid Services (CMS) and its contracted auditors are turning their watchdog eyes toward nursing homes, critical access hospitals (CAHs), and acute-care hospitals.
In October 2022, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) published a new audit project titled “Potentially Preventable Hospitalizations of Medicare-Eligible Skilled Nursing Facility Residents.”
OIG identified nursing facilities with high rates of Medicaid resident transfers to hospitals for urinary tract infections (UTIs). The OIG described UTIs as being “often preventable and treatable in the nursing facility setting without requiring hospitalization.” A 2019 OIG audit found that nursing facilities often did not provide UTI detection...