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Medicare Payments for Inpatient Claims With Mechanical Ventilation

We will review Medicare payments for inpatient hospital claims with certain Medicare Severity Diagnosis Related Group (MS-DRG) assignments that require mechanical ventilation to determine whether hospitals' DRG assignments and resultant Medicare payments were appropriate. Mechanical ventilation is the use of a ventilator to take over active breathing for a patient. For certain MS-DRGs to qualify for Medicare coverage, a beneficiary must have received more than 96 hours of mechanical ventilation. Our review will include claims for beneficiaries who received more than 96 hours of mechanical ventilation. Previous OIG reviews identified improper payments made because hospitals inappropriately billed for beneficiaries who did not receive at least 96 hours of mechanical ventilation.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
November 2021 Centers for Medicare and Medicaid Services Medicare Payments for Inpatient Claims With Mechanical Ventilation Office of Audit Services W-00-22-35879 2023