Medicare Incorrectly Paid Hospitals for Beneficiaries Who Had Not Received 96 or More Hours of Mechanical Ventilation.

摘要

The MS-DRG payment is, with certain exceptions, intended to be payment in full to the hospital for all inpatient costs associated with the beneficiarys stay. For MS-DRGs 207 and 870 to be assigned to a claim, a beneficiary must have received 96 or more hours of mechanical ventilation. A hospital indicates that a beneficiary has met this requirement by using procedure code 96.72. If a beneficiary received fewer than 96 hours of mechanical ventilation, the beneficiarys stay is assigned to an MS-DRG with a lower severity level, resulting in a lower payment. Our audit covered $12,764,239 in Medicare payments to 290 hospitals for 377 inpatient claims that we selected as at risk for billing errors. These claims had MS-DRGs 207 or 870 and dates of service in calendar years 2009 through 2011 with patient stays in the hospital of 4 days (the equivalent of 96 hours) or fewer.