| Service Type Billed to Carriers (BETOS codes) |
Projected Improper Payment |
Paid Claims Error Rate |
95% Confidence Interval |
Type of Error |
| No Documentation |
Insufficient Documentation |
Medically Unnecessary Services |
Incorrect Coding |
Other |
/
|
/
|
/
|
/
|
/
|
/
|
/
|
/
|
/
|
| Hospital visit - initial |
$190,653,155 |
17.2% |
14.5% - 19.9% |
5.3% |
28.5% |
0.0% |
65.3% |
1.0% |
| Other drugs |
$573,326,552 |
12.2% |
3.7% - 20.8% |
83.6% |
1.1% |
0.2% |
15.1% |
0.0% |
| Consultations |
$507,038,019 |
15.4% |
14.0% - 16.7% |
2.7% |
8.6% |
0.0% |
88.6% |
0.1% |
| Office visits - established |
$487,828,985 |
5.2% |
4.8% - 5.5% |
5.8% |
13.1% |
1.5% |
78.6% |
1.0% |
| Hospital visit - subsequent |
$479,372,543 |
11.0% |
9.5% - 12.4% |
7.3% |
47.7% |
0.2% |
44.5% |
0.3% |
| All Other Codes |
$384,368,679 |
1.4% |
1.1% - 1.7% |
28.2% |
45.1% |
4.3% |
18.3% |
4.1% |
| Office visits - new |
$167,979,860 |
15.5% |
13.5% - 17.5% |
3.8% |
1.9% |
0.1% |
93.8% |
0.3% |
| Minor procedures - other (Medicare fee schedule) |
$155,838,882 |
5.3% |
4.2% - 6.3% |
15.9% |
58.6% |
8.3% |
17.0% |
0.2% |
| Nursing home visit |
$117,502,635 |
12.1% |
10.2% - 14.1% |
10.2% |
25.2% |
3.6% |
60.7% |
0.3% |
| Chiropractic |
$91,432,131 |
15.5% |
12.5% - 18.5% |
0.6% |
74.2% |
13.0% |
11.7% |
0.4% |
| Emergency room visit |
$81,170,524 |
5.2% |
4.1% - 6.4% |
1.7% |
9.8% |
0.0% |
88.5% |
0.0% |
| Ambulance |
$75,735,222 |
2.3% |
1.0% - 3.6% |
0.0% |
21.7% |
48.2% |
14.3% |
15.8% |
| Chemotherapy |
$68,742,076 |
3.2% |
( 0.5%) - 6.8% |
79.8% |
0.6% |
0.0% |
6.5% |
13.0% |
| Dialysis services (Non MFS) |
$57,028,358 |
8.4% |
3.7% - 13.1% |
2.0% |
82.2% |
0.0% |
15.0% |
0.8% |
| Hospital visit - critical care |
$49,951,053 |
8.6% |
1.8% - 15.5% |
35.3% |
27.5% |
0.0% |
30.0% |
7.2% |
| Other tests - other |
$40,677,030 |
3.0% |
0.7% - 5.4% |
1.2% |
82.7% |
11.0% |
3.9% |
1.3% |
| Lab tests - other (non-Medicare fee schedule) |
$31,848,867 |
1.8% |
1.0% - 2.5% |
36.9% |
33.5% |
22.3% |
3.1% |
4.2% |
| Specialist - opthamology |
$31,830,341 |
1.7% |
1.0% - 2.5% |
7.5% |
53.6% |
4.3% |
34.5% |
0.0% |
| All Codes With Less Than 30 Claims |
$30,074,229 |
1.6% |
( 0.3%) - 3.5% |
55.3% |
38.0% |
1.4% |
5.3% |
0.0% |
| Specialist - psychiatry |
$28,884,098 |
3.2% |
( 0.5%) - 6.8% |
62.3% |
17.9% |
3.6% |
1.2% |
15.0% |
| Minor procedures - musculoskeletal |
$26,774,531 |
2.8% |
( 0.2%) - 5.8% |
1.7% |
70.8% |
11.0% |
3.1% |
13.4% |
| All Type of Services (Incl. Codes Not Listed) |
$3,678,057,770 |
5.0% |
4.4% - 5.7% |
22.9% |
25.7% |
3.0% |
46.8% |
1.7% |
|
|