| Carriers (HCPCS), DMERCs (HCPCS), and FIs (Type of Bill) |
Insufficient Documentation Errors |
| Paid Claims Error Rate |
Projected Improper Payments |
95% Confidence Interval |
/
|
/
|
/
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/
|
| Hospital-outpatient (HHA-A also)(under OPPS 13X must be used for ASC claims submitted for OPPS payment -- eff. 7/00) (13) |
1.4% |
$252,717,184 |
1.0% - 1.7% |
| Subsequent hospital care (99232) |
4.5% |
$98,916,844 |
3.2% - 5.8% |
| SNF-inpatient (including Part A) (21) |
0.5% |
$75,037,569 |
( 0.1%) - 1.2% |
| Subsequent hospital care (99233) |
6.2% |
$70,826,277 |
3.4% - 9.1% |
| ESRD related svs 4+mo 20+yrs (G0317) |
8.8% |
$44,518,105 |
3.1% - 14.6% |
| Chiropractic manipulation (98941) |
11.3% |
$41,814,339 |
7.9% - 14.8% |
| Initial hospital care (99223) |
5.0% |
$35,249,167 |
2.3% - 7.7% |
| Subsequent hospital care (99231) |
7.9% |
$34,753,978 |
3.7% - 12.1% |
| Therapeutic exercises (97110) |
4.4% |
$28,636,453 |
2.9% - 6.0% |
| Clinic-hospital based or independent renal dialysis facility (72) |
0.5% |
$25,997,646 |
0.2% - 0.9% |
| SNF-inpatient or home health visits (Part B only) (22) |
2.1% |
$23,788,447 |
1.0% - 3.1% |
| Office/outpatient visit, est (99213) |
0.5% |
$20,271,562 |
0.3% - 0.7% |
| Office/outpatient visit, est (99211) |
11.8% |
$18,523,261 |
8.4% - 15.2% |
| Chiropractic manipulation (98942) |
20.4% |
$16,035,608 |
9.3% - 31.5% |
| Office/outpatient visit, est (99214) |
0.4% |
$15,418,735 |
0.2% - 0.7% |
| Initial inpatient consult (99254) |
2.1% |
$14,252,568 |
0.4% - 3.9% |
| HHA-outpatient (HHA-A also) (33) |
0.3% |
$13,101,799 |
( 0.2%) - 0.8% |
| Critical care, first hour (99291) |
2.3% |
$11,888,572 |
( 0.5%) - 5.1% |
| bls (A0428) |
1.6% |
$11,825,717 |
( 0.1%) - 3.4% |
| SNF-outpatient (HHA-A also) (23) |
5.4% |
$11,776,482 |
( 0.2%) - 11.0% |
| All Other Codes |
0.6% |
$550,547,101 |
0.6% - 0.7% |
| Overall |
1.0% |
$1,415,897,415 |
0.9% - 1.1% |
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