| Service Types Billed to Carriers (BETOS) |
Paid Claims Error Rate |
| Error Rate |
Number of Line Items (Sample) |
Projected Improper Payments |
Standard Error |
95% Confidence Interval |
/
|
/
|
/
|
/
|
/
|
/
|
| Anesthesia |
1.1% |
976 |
$15,156,203 |
0.3% |
0.4% - 1.7% |
| Emergency room visit |
5.2% |
1,581 |
$81,170,524 |
0.6% |
4.1% - 6.4% |
| Ambulance |
2.3% |
2,577 |
$75,735,222 |
0.7% |
1.0% - 3.6% |
| Chemotherapy |
3.2% |
313 |
$68,742,076 |
1.9% |
( 0.5%) - 6.8% |
| Dialysis services (Non MFS) |
8.4% |
237 |
$57,028,358 |
2.4% |
3.7% - 13.1% |
| Hospital visit - critical care |
8.6% |
274 |
$49,951,053 |
3.5% |
1.8% - 15.5% |
| Other tests - other |
3.0% |
1,898 |
$40,677,030 |
1.2% |
0.7% - 5.4% |
| Lab tests - other (non-Medicare fee schedule) |
1.8% |
12,549 |
$31,848,867 |
0.4% |
1.0% - 2.5% |
| Specialist - opthamology |
1.7% |
3,125 |
$31,830,341 |
0.4% |
1.0% - 2.5% |
| All Codes With Less Than 30 Claims |
1.6% |
379 |
$30,074,229 |
1.0% |
( 0.3%) - 3.5% |
| Specialist - psychiatry |
3.2% |
1,767 |
$28,884,098 |
1.8% |
( 0.5%) - 6.8% |
| Minor procedures - musculoskeletal |
2.8% |
1,056 |
$26,774,531 |
1.5% |
( 0.2%) - 5.8% |
| Advanced imaging - MRI: other |
1.4% |
395 |
$24,632,741 |
0.6% |
0.2% - 2.7% |
| Standard imaging - nuclear medicine |
1.2% |
1,236 |
$23,205,612 |
0.6% |
0.0% - 2.4% |
| Standard imaging - musculoskeletal |
3.1% |
2,707 |
$22,138,564 |
0.7% |
1.8% - 4.5% |
| Lab tests - other (Medicare fee schedule) |
1.6% |
1,765 |
$21,394,815 |
0.5% |
0.6% - 2.5% |
| Major procedure - Other |
1.9% |
255 |
$17,225,518 |
1.1% |
( 0.3%) - 4.1% |
| Other tests - electrocardiograms |
4.5% |
2,609 |
$17,153,945 |
0.6% |
3.3% - 5.7% |
| Advanced imaging - MRI: brain |
1.9% |
188 |
$15,062,714 |
1.3% |
( 0.6%) - 4.4% |
| Echography - carotid arteries |
5.1% |
256 |
$14,652,514 |
3.4% |
( 1.6%) - 11.7% |
| Endoscopy - colonoscopy |
1.9% |
332 |
$14,339,539 |
1.1% |
( 0.3%) - 4.0% |
| Echography - other |
2.9% |
554 |
$13,997,290 |
1.3% |
0.3% - 5.4% |
| Major procedure, cardiovascualr-Coronary angioplasty (PTCA) |
5.0% |
62 |
$12,982,279 |
0.9% |
3.2% - 6.8% |
| Major procedure, cardiovascular-Other |
1.1% |
342 |
$10,941,587 |
1.0% |
( 0.8%) - 3.0% |
| Echography - abdomen/pelvis |
4.0% |
417 |
$10,924,047 |
2.7% |
( 1.3%) - 9.3% |
| Ambulatory procedures - other |
1.9% |
745 |
$10,638,009 |
0.8% |
0.3% - 3.5% |
| Specialist - other |
4.4% |
351 |
$10,380,833 |
1.5% |
1.6% - 7.3% |
| Home visit |
6.6% |
184 |
$10,270,812 |
1.9% |
2.8% - 10.3% |
| Standard imaging - chest |
2.6% |
2,851 |
$9,890,914 |
0.6% |
1.4% - 3.8% |
| Minor procedures - skin |
0.9% |
1,462 |
$9,400,891 |
0.3% |
0.3% - 1.5% |
| Other - Medicare fee schedule |
6.9% |
310 |
$8,456,916 |
2.5% |
1.9% - 11.8% |
| Dialysis services |
8.0% |
135 |
$7,752,145 |
4.8% |
( 1.5%) - 17.5% |
| Standard imaging - other |
2.9% |
736 |
$7,582,086 |
1.0% |
1.0% - 4.9% |
| Ambulatory procedures - skin |
0.5% |
1,645 |
$6,254,419 |
0.1% |
0.2% - 0.8% |
| Other tests - cardiovascular stress tests |
1.8% |
481 |
$6,107,076 |
0.8% |
0.3% - 3.3% |
| Advanced imaging - CAT: other |
0.4% |
1,155 |
$5,110,982 |
0.2% |
0.1% - 0.7% |
| Oncology - radiation therapy |
0.5% |
558 |
$4,685,506 |
0.3% |
( 0.1%) - 1.1% |
| Other tests - EKG monitoring |
3.5% |
145 |
$4,497,852 |
1.4% |
0.7% - 6.2% |
| Lab tests - blood counts |
1.7% |
2,677 |
$4,412,350 |
0.3% |
1.0% - 2.3% |
| Echography - eye |
3.4% |
205 |
$4,192,982 |
1.3% |
0.9% - 5.9% |
| Standard imaging - breast |
1.2% |
905 |
$4,025,359 |
0.6% |
( 0.1%) - 2.4% |
| Immunizations/Vaccinations |
1.3% |
2,233 |
$3,704,727 |
0.4% |
0.6% - 2.0% |
| Advanced imaging - CAT: head |
1.2% |
465 |
$3,693,951 |
0.8% |
( 0.3%) - 2.7% |
| Echography - heart |
0.3% |
1,662 |
$3,339,707 |
0.2% |
( 0.0%) - 0.6% |
| Lab tests - routine venipuncture (non Medicare fee schedule) |
2.0% |
5,141 |
$3,080,440 |
0.3% |
1.4% - 2.7% |
| Imaging/procedure - other |
1.1% |
542 |
$2,940,869 |
0.6% |
( 0.1%) - 2.2% |
| Lab tests - automated general profiles |
0.9% |
2,739 |
$2,718,423 |
0.3% |
0.4% - 1.4% |
| Eye procedure - other |
0.6% |
189 |
$2,666,812 |
0.6% |
( 0.5%) - 1.7% |
| Oncology - other |
0.9% |
471 |
$2,424,068 |
0.5% |
( 0.1%) - 1.9% |
| Lab tests - urinalysis |
3.8% |
1,539 |
$2,129,171 |
0.6% |
2.5% - 5.0% |
| Endoscopy - bronchoscopy |
2.3% |
40 |
$1,795,010 |
0.4% |
1.5% - 3.2% |
| Endoscopy - other |
1.1% |
77 |
$1,439,088 |
1.0% |
( 1.0%) - 3.1% |
| Endoscopy - upper gastrointestinal |
0.3% |
221 |
$1,438,916 |
0.2% |
( 0.1%) - 0.7% |
| Standard imaging - contrast gastrointestinal |
1.4% |
129 |
$1,111,461 |
0.8% |
( 0.2%) - 3.1% |
| Lab tests - glucose |
5.7% |
505 |
$1,079,928 |
2.7% |
0.5% - 10.9% |
| Ambulatory procedures - musculoskeletal |
0.3% |
93 |
$980,558 |
0.3% |
( 0.3%) - 0.9% |
| Endoscopy - cystoscopy |
0.3% |
145 |
$976,422 |
0.3% |
( 0.3%) - 0.9% |
| Other - non-Medicare fee schedule |
1.8% |
456 |
$691,471 |
0.9% |
( 0.1%) - 3.6% |
| Lab tests - bacterial cultures |
1.0% |
596 |
$691,053 |
0.4% |
0.2% - 1.7% |
| Medical/surgical supplies |
0.0% |
58 |
$103 |
0.0% |
( 0.0%) - 0.0% |
| Endoscopy - laryngoscopy |
0.0% |
42 |
N/A |
N/A |
N/A |
| Enteral and parenteral |
0.0% |
35 |
N/A |
N/A |
N/A |
| Eye procedure - cataract removal/lens insertion |
0.0% |
260 |
N/A |
N/A |
N/A |
| Imaging/procedure - heart including cardiac catheter |
0.0% |
433 |
N/A |
N/A |
N/A |
| Major procedure - explor/decompr/excisdisc |
0.0% |
54 |
N/A |
N/A |
N/A |
| Major procedure, cardiovascular-Pacemaker insertion |
0.0% |
46 |
N/A |
N/A |
N/A |
| Major procedure, orthopedic - other |
0.0% |
128 |
N/A |
N/A |
N/A |
| No Service Code |
0.0% |
59 |
N/A |
N/A |
N/A |
| Orthotic devices |
0.0% |
50 |
N/A |
N/A |
N/A |
| All Type of Services (Incl. Codes Not Listed) |
5.0% |
112,362 |
$3,678,057,770 |
0.3% |
4.4% - 5.7% |
| Other drugs |
12.2% |
2,450 |
$573,326,552 |
4.4% |
3.7% - 20.8% |
| Consultations |
15.4% |
2,412 |
$507,038,019 |
0.7% |
14.0% - 16.7% |
| Office visits - established |
5.2% |
17,013 |
$487,828,985 |
0.2% |
4.8% - 5.5% |
| Hospital visit - subsequent |
11.0% |
6,303 |
$479,372,543 |
0.7% |
9.5% - 12.4% |
| Hospital visit - initial |
17.2% |
846 |
$190,653,155 |
1.4% |
14.5% - 19.9% |
| Office visits - new |
15.5% |
1,249 |
$167,979,860 |
1.0% |
13.5% - 17.5% |
| Minor procedures - other (Medicare fee schedule) |
5.3% |
7,492 |
$155,838,882 |
0.5% |
4.2% - 6.3% |
| Nursing home visit |
12.1% |
1,699 |
$117,502,635 |
1.0% |
10.2% - 14.1% |
| Chiropractic |
15.5% |
2,095 |
$91,432,131 |
1.5% |
12.5% - 18.5% |
|
|