The HHS Office of the Inspector General has issued a new report - “Medicare Improperly Paid Hospitals an Estimated $79M for Enrollees Who Had Received Mechanical Ventilation.” This is based on 2023 data (typical time discrepancies for these types of federal reports.)
In the report, the Office of the Inspector General found that hospitals didn’t fully comply with Medicare requirements for claims with certain Medicare Severity Diagnosis-Related Groups that required more than 96 consecutive hours of mechanical ventilation. This resulted in $79 million in improper payments.
On your claims for mechanical ventilation, use the right procedure and diagnosis codes, including codes for the correct number of hours. Review the Ventilators provider compliance tip for more information.