Medicare Inpatient Hospital Billing for Sepsis

Sepsis is the body's extreme response to an infection. It is a life-threatening, emergency medical issue that often progresses quickly and responds best to early intervention. 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. This study will analyze Medicare claims to assess patterns in the inpatient hospital billing of sepsis in 2023 and describe how the billing of sepsis varied among hospitals. We will also estimate the costs to Medicare associated with using the broader, rather than the narrower, definition of sepsis.

Announced or Revised	Agency	Title	Component	Report Number(s)	Expected Issue Date (FY)
March 2024	Centers for Medicare and Medicaid Services, Centers for Disease Control and Prevention	Medicare Inpatient Hospital Billing for Sepsis	Office of Evaluation and Inspections	OEI-02-24-00230	2025