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Coding Corner Tips: Medicare Inpatient Hospital Billing Review for Sepsis
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OIG Workplan: Review Medicare Inpatient Hospital Billing for Sepsis

The OIG will be reviewing Medicare claims to assess patterns in the inpatient hospital billing of sepsis in 2023 and describe how the billing of sepsis varied among hospitals. 

The definition of and guidance for sepsis have changed over the years in attempts to identify it more accurately.

The definition of sepsis was updated in 2016 by an international task force to better differentiate sepsis from a general infection. This narrower definition is widely recognized by groups such as the World Health Organization. However, CMS and CDC currently recognize an older, broader definition.

Sepsis is a frequently billed diagnosis in Medicare. There are concerns that hospitals may be taking advantage of this broader definition, as they have a financial incentive to do so.  

Now is a good time to do a review of your Sepsis records (both retrospectively and concurrently).                                    e4health can assist with those audits!

Looking for Coding help?

Learn more about e4health Coding Solutions. Our Team is leading the way in Healthcare Coding and Education.

e4health Coding Education

Need help to earn CEUs or education your team? Visit the IQ Education Center and get your free account or contact us for more information.

e4health is dedicated to elevating the business of healthcare. We are committed to offering support and the most current information and updates to collaborate with coding and CDI professionals to realize their fullest potential. We enthusiastically seek opportunities to develop ourselves and each other. We understand that knowledge is the key to success for our clients navigating the ever-changing health information management landscape.

Upcoming Webinar

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📅 We invite you to earn free AHIMA and AAPC CEUs when you participate in this upcoming 3-part webinar series with e4health’s Director of Education, Kim Felix, and Clinical Documentation Specialist, Lori Harbison, as they thoroughly tackle the topic of Sepsis.

The first session of this 3-part series will be held June 4th, from 12-1 PM EST. As with any speaking event led by Kim and Lori, this will surely be one you don’t want to miss!

✅ To just signup for this session, please click here.

✅ To signup for this session and the following two sessions, please click here.

We look forward to seeing everyone there!


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Kim Felix, RHIA, CCS 

Director of Education

 (215) 200-1788



Lori Harbison, LPN, CCDS, CDIP, CCS

Coding Operations Manager

 (216) 501-2058




e4health is Empowering Better Health. Serving more than 400 health systems and providers nationwide, e4health solves the most difficult challenges in the mid-revenue cycle with innovative and flexible healthcare solutions that deliver results, drive change, protect investments, and support long term value. Learn more at e4.health.

The information and opinions presented here are based on the experience, training, and interpretation of e4health. Although the information has been researched and reviewed for accuracy, e4health does not accept any responsibility or liability regarding errors, omissions, misuse, or misinterpretation. This information is intended as a guide; it should not be considered a legal/consulting opinion or advice.