Medicare overpaid hospitals $19.6 million for services that were incorrectly logged as a result of human error, according to a new inspector general report.
Medicare patients who need a ventilator or respirator to breathe for them must go through at least 96 hours of consecutive mechanical ventilation, or four days. But of 200 claims that were tested, 63 were incorrectly marked as meeting that requirement, according to the Department of Health and Human Services inspector general. As a result, Medicare overpaid $1.5 million for the treatments.
Another problem that contributed to the overbilling was clerical errors in which the wrong procedure code was entered for the treatment.
Over two years, the inspector general reported that hospitals received overpayments of $3.7 million for claims with stays of four days or fewer and overpayaments of $15.9 million for claims with a stay of at least five days.
The inspector general recommended that the Centers for Medicare and Medicaid Services “ensure that the Medicare contractors recover the $1.5 million in identified overpayments for the sampled claims.”
The watchdog also suggested that the CMS revise its length-of-stays to take into account the ventilation start date for patients who are expected to need a respirator for four days or fewer. That could save CMS $15.9 million over the next two years, the report said.
The inspector general also suggested that the rest of the Medicare claims be reviewed, so that any potential errors can be identified, after which any overpayments can be recovered “to the extent feasible and allowed under the law.”
The last recommendation the report made was that the CMS have its contractors review any claims of five or more days made with procedure code 96.72 and recover any overpayments.
The agency agreed to implement all five suggestions.
