by CMS - MLNConnects
Jun 18th, 2025
Compliance
Mechanical Ventilation: Bill Correctly for Inpatient Claims
In a report, the Office of the Inspector General found that hospitals didn’t fully comply with Medicare requirements for claims with certain Medicare Severity Diagnosis-Related Groups that required more than 96 consecutive hours of mechanical ventilation. This resulted in $79 million in improper payments.
On your claims for mechanical ventilation, use the right procedure and diagnosis codes, including codes for the correct number of hours. Review the Ventilators provider compliance tip for more information.
SNF Services: Prevent Claim Denials
In 2023, the improper payment rate for skilled nursing facility (SNF) inpatient claims was 14.9%, with a projected improper payment amount of $4.8 billion (see 2023 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF)). Learn how to bill correctly for these services. Review the SNF Services provider compliance tip for more information, including:
- Denial reasons and how to prevent them
- Case mix prospective payment
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