| Service Type Billed to DMERCs (SADMERC Policy Group) |
Projected Improper Payment |
Paid Claims Error Rate |
95% Confidence Interval |
Type of Error |
| No Documentation |
Insufficient Documentation |
Medically Unnecessary Services |
Incorrect Coding |
Other |
/
|
/
|
/
|
/
|
/
|
/
|
/
|
/
|
/
|
| All Policy Groups with Less than 30 Claims |
$228,032,498 |
15.4% |
4.6% - 26.1% |
54.2% |
0.0% |
44.2% |
1.6% |
0.0% |
| Nebulizers & Related Drugs |
$167,572,569 |
15.3% |
8.2% - 22.5% |
60.5% |
0.5% |
23.5% |
15.4% |
0.1% |
| Negative Pressure Wound Therapy |
$125,678,545 |
50.4% |
27.5% - 73.3% |
100.0% |
0.0% |
0.0% |
0.0% |
0.0% |
| Glucose Monitor |
$114,464,254 |
9.5% |
7.9% - 11.0% |
10.2% |
2.0% |
76.2% |
10.7% |
1.0% |
| Enteral Nutrition |
$109,383,911 |
18.9% |
7.7% - 30.0% |
77.3% |
0.0% |
15.6% |
7.2% |
0.0% |
| Support Surfaces |
$33,855,619 |
20.1% |
6.2% - 34.0% |
99.8% |
0.0% |
0.2% |
0.0% |
0.0% |
| CPAP |
$31,149,480 |
7.7% |
4.1% - 11.3% |
24.0% |
20.3% |
52.7% |
1.3% |
1.7% |
| Lower Limb Orthoses |
$28,829,394 |
13.3% |
0.4% - 26.2% |
96.0% |
0.0% |
4.0% |
0.0% |
0.0% |
| Oxygen Supplies/Equipment |
$27,376,887 |
1.3% |
0.8% - 1.8% |
25.6% |
0.0% |
59.2% |
12.4% |
2.7% |
| Wheelchairs Options/Accessories |
$27,314,967 |
12.0% |
( 3.9%) - 27.9% |
5.7% |
0.5% |
31.3% |
0.4% |
62.1% |
| All Other Codes |
$22,024,283 |
3.0% |
1.6% - 4.3% |
32.3% |
0.6% |
55.2% |
4.8% |
7.1% |
| Wheelchairs Manual |
$15,274,364 |
6.2% |
3.9% - 8.4% |
1.7% |
3.2% |
63.5% |
23.5% |
8.1% |
| Suction Pump |
$14,458,892 |
53.1% |
10.8% - 95.5% |
87.5% |
0.0% |
12.5% |
0.0% |
0.0% |
| Immunosuppressive Drugs |
$12,740,563 |
3.0% |
0.4% - 5.6% |
0.0% |
0.0% |
78.1% |
0.0% |
21.9% |
| Ostomy Supplies |
$11,453,618 |
7.8% |
0.5% - 15.0% |
21.6% |
0.0% |
74.0% |
4.4% |
0.0% |
| Spinal Orthoses |
$9,908,724 |
13.3% |
( 2.3%) - 28.9% |
98.7% |
0.0% |
1.3% |
0.0% |
0.0% |
| Surgical Dressings |
$9,827,558 |
10.8% |
( 1.7%) - 23.4% |
89.3% |
0.3% |
10.4% |
0.0% |
0.0% |
| Diabetic Shoes |
$8,198,843 |
4.9% |
0.8% - 9.0% |
10.9% |
13.4% |
52.6% |
23.2% |
0.0% |
| Respiratory Assist Device |
$6,283,663 |
7.1% |
0.5% - 13.7% |
77.8% |
0.0% |
22.2% |
0.0% |
0.0% |
| Lenses |
$5,909,435 |
8.7% |
2.2% - 15.1% |
5.6% |
21.9% |
68.5% |
4.1% |
0.0% |
| Upper Limb Orthoses |
$5,894,418 |
14.2% |
0.5% - 28.0% |
93.4% |
0.0% |
6.6% |
0.0% |
0.0% |
| All Type of Services (Incl. Codes Not Listed) |
$1,015,632,486 |
10.3% |
8.1% - 12.5% |
56.8% |
1.2% |
33.5% |
6.0% |
2.5% |
|
|