| Carriers (HCPCS), DMERCs (HCPCS), and FIs (Type of Bill) |
Underpayment Coding Errors |
| Paid Claims Error Rate |
Projected Improper Payments |
95% Confidence Interval |
/
|
/
|
/
|
/
|
| SNF-inpatient (including Part A) (21) |
0.1% |
$14,244,949 |
( 0.0%) - 0.2% |
| Hospital-outpatient (HHA-A also)(under OPPS 13X must be used for ASC claims submitted for OPPS payment -- eff. 7/00) (13) |
0.3% |
$50,516,543 |
0.1% - 0.4% |
| HHA-outpatient (HHA-A also) (33) |
1.0% |
$45,621,971 |
0.3% - 1.8% |
| Office/outpatient visit, est (99213) |
0.6% |
$23,503,372 |
0.4% - 0.7% |
| Office/outpatient visit, est (99212) |
3.2% |
$22,205,833 |
2.5% - 3.9% |
| Clinic-hospital based or independent renal dialysis facility (72) |
0.3% |
$16,748,581 |
0.1% - 0.5% |
| HHA-inpatient or home health visits (Part B only) (32) |
0.2% |
$10,626,839 |
0.0% - 0.3% |
| Non esrd epoetin alpha inj (Q0136) |
2.2% |
$9,883,886 |
( 1.5%) - 5.8% |
| Mri brain w/o dye (70551) |
6.3% |
$6,743,153 |
( 5.6%) - 18.3% |
| Subsequent hospital care (99231) |
1.5% |
$6,733,558 |
0.1% - 2.9% |
| Office/outpatient visit, est (99211) |
3.9% |
$6,115,032 |
1.8% - 6.0% |
| Emergency dept visit (99283) |
1.6% |
$4,048,179 |
0.5% - 2.8% |
| EF complet w/intact nutrient (B4150) |
2.7% |
$3,576,503 |
( 1.0%) - 6.5% |
| Therapeutic exercises (97110) |
0.4% |
$2,557,597 |
( 0.1%) - 0.9% |
| Hospital-other (Part B) (14) |
0.2% |
$2,524,785 |
0.0% - 0.4% |
| Chiropractic manipulation (98940) |
1.7% |
$2,376,540 |
0.0% - 3.3% |
| Office/outpatient visit, est (99214) |
0.1% |
$2,026,695 |
( 0.0%) - 0.1% |
| Special facility or ASC surgery-rural primary care hospital (eff 10/94) (85) |
0.1% |
$1,843,263 |
0.0% - 0.2% |
| Eye exam established pat (92012) |
0.5% |
$1,788,044 |
( 0.0%) - 1.1% |
| Subsequent hospital care (99232) |
0.1% |
$1,660,525 |
0.0% - 0.2% |
| All Other Codes |
0.1% |
$58,267,125 |
0.1% - 0.1% |
| Overall |
0.2% |
$293,612,971 |
0.2% - 0.2% |
|
|