News: OIG says Medicare improperly paid hospitals millions for beneficiaries on mechanical ventilation

Medicare improperly paid hospitals for beneficiaries who had not received 96 or more consecutive hours of mechanical ventilation, according to a report released by the Office of the Inspector General (OIG).

The agency found that 63 of the 200 claims it reviewed from July 1, 2012, through June 30, 2014 incorrectly used ICD-9 code 96.72, resulting in $1,488,165 of overpayments. The audit covered 2,986 claims with MS-DRGs 207 or 870 and beneficiary lengths of stay up to 49 days. The claims did not indicate when mechanical ventilation ended, so at-risk claims were identified based on the procedure start date and the patient’s discharge date.

The hospitals confirmed that claims were improperly billed and generally attributed the errors to incorrectly counting the number of hours that beneficiaries received mechanical ventilation or to clerical errors in selecting the appropriate procedure code, according to the report.

CMS concurred with the OIG’s recommendations, and agreed to provide additional guidance to hospitals on the correct billing of mechanical ventilation claims, emphasizing correct billing of claims with a potential procedure length of five days. This could result in savings of an estimated $15,853,359 over a two-year period, says the OIG.