| Service Types for Which QIOs are Responsible (DRG) |
Projected Improper Payment |
Paid Claims Error Rate |
95% Confidence Interval |
Type of Error |
| No Documentation |
Insufficient Documentation |
Medically Unnecessary Services |
Incorrect Coding |
Other |
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| ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >17 W CC |
$187.1M |
15.0% |
11.6% - 18.3% |
1.4% |
0.0% |
84.6% |
9.0% |
5.0% |
| CHEST PAIN |
$140.7M |
23.6% |
18.4% - 28.9% |
1.7% |
0.0% |
86.0% |
4.1% |
8.2% |
| CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH |
$136.4M |
8.2% |
0.5% - 16.0% |
0.0% |
0.0% |
48.0% |
5.9% |
46.1% |
| OTHER PERMANENT CARDIAC PACEMAKER IMPLANT |
$113.3M |
10.3% |
4.1% - 16.5% |
0.0% |
0.0% |
65.8% |
16.3% |
17.9% |
| NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 W CC |
$99.8M |
9.9% |
7.1% - 12.6% |
1.8% |
0.0% |
66.1% |
16.7% |
15.4% |
| HEART FAILURE & SHOCK |
$92.8M |
2.6% |
1.7% - 3.5% |
7.1% |
0.0% |
54.2% |
25.3% |
13.3% |
| MEDICAL BACK PROBLEMS |
$90.8M |
24.6% |
16.5% - 32.6% |
0.0% |
0.0% |
93.6% |
3.5% |
2.8% |
| OTHER KIDNEY & URINARY TRACT PROCEDURES |
$81.2M |
19.0% |
3.3% - 34.6% |
35.3% |
0.0% |
35.9% |
17.6% |
11.3% |
| OTHER CIRCULATORY SYSTEM DIAGNOSES W CC |
$79.4M |
10.6% |
5.9% - 15.2% |
18.6% |
0.0% |
37.9% |
38.6% |
5.0% |
| OTHER VASCULAR PROCEDURES W CC |
$76.8M |
6.3% |
2.1% - 10.4% |
16.9% |
0.0% |
42.6% |
39.1% |
1.3% |
| RENAL FAILURE |
$74.3M |
5.0% |
3.2% - 6.8% |
3.5% |
0.0% |
55.7% |
34.1% |
6.8% |
| CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O COMPLEX DIAG |
$69.1M |
14.1% |
8.2% - 20.0% |
0.0% |
0.0% |
71.0% |
16.8% |
12.2% |
| SIMPLE PNEUMONIA & PLEURISY AGE >17 W CC |
$68.3M |
2.4% |
1.5% - 3.4% |
13.0% |
0.0% |
23.3% |
48.8% |
14.9% |
| OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >17 W CC |
$68.2M |
11.9% |
5.3% - 18.5% |
0.7% |
0.0% |
91.2% |
8.1% |
0.0% |
| KIDNEY & URINARY TRACT INFECTIONS AGE >17 W CC |
$66.6M |
6.8% |
3.9% - 9.6% |
3.2% |
0.0% |
47.7% |
47.1% |
2.0% |
| MAJOR JOINT & LIMB REATTACHMENT PROCEDURES OF LOWER EXTREMITY |
$66.3M |
1.7% |
0.4% - 3.1% |
10.1% |
0.0% |
74.8% |
14.8% |
0.3% |
| SEPTICEMIA AGE >17 |
$63.7M |
2.3% |
1.1% - 3.6% |
0.0% |
0.0% |
13.8% |
86.2% |
0.0% |
| SYNCOPE & COLLAPSE W CC |
$54.8M |
11.7% |
7.0% - 16.3% |
0.8% |
0.0% |
69.2% |
15.7% |
14.3% |
| CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC |
$53.7M |
6.2% |
3.7% - 8.8% |
1.2% |
0.0% |
56.7% |
31.2% |
10.9% |
| ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >17 W/O CC |
$51.3M |
25.2% |
15.9% - 34.4% |
0.0% |
0.0% |
79.3% |
13.0% |
7.7% |
| Overall |
$4,934.6M |
4.9% |
4.5% - 5.2% |
3.6% |
0.0% |
59.5% |
29.2% |
7.7% |