According to CMS, hospitals can assign MS-DRGs 207 and 870 — respiratory system diagnosis and septicemia, respectively — if, and only if, a beneficiary has received 96 or more hours of mechanical ventilation. Mechanical ventilation, according to the report, is the use of a ventilator or respirator to take over the active breathing of a patient.
The OIG audited these types of claims made by 290 hospitals between 2009 and 2011. Of the 377 audited claims, only 14 were correctly billed. This resulted in $7.7 million in overpayments due to the codes’ higher reimbursements. Hospitals attributed the mistakes to incorrectly counting the hours a patient was on mechanical ventilation and other clerical errors.
CMS said it is not possible to recover all of the overpayments, as some are beyond the four-year recovery limit. However, CMS said it would try to collect the overpayments for the remaining claims.
More Articles on Hospitals and Medicare Overpayments:
OIG: Sanford Medical Center Overbilled Medicare by $65k
OIG Slams 3 Hospitals, Health Systems for $2.3M in Medicare Overpayments
OIG: Hospital of the University of Pennsylvania Must Refund $538k
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