| Carriers (HCPCS), DMERCs (HCPCS), FIs (Type of Bill), and QIOs (DRG) |
Incorrect Coding Errors |
| Paid Claims Error Rate |
Projected Improper Payments |
95% Confidence Interval |
/
|
/
|
/
|
/
|
| Hospital-outpatient (HHA-A also)(under OPPS 13X must be used for ASC claims submitted for OPPS payment -- eff. 7/00) (13) |
2.3% |
$435,624,395 |
( 0.3%) - 5.0% |
| Office/outpatient visit, est (99214) |
5.4% |
$199,783,103 |
4.9% - 6.0% |
| SNF-inpatient (including Part A) (21) |
1.1% |
$155,000,635 |
0.7% - 1.4% |
| SEPTICEMIA AGE >17 |
2.0% |
$54,901,402 |
0.8% - 3.2% |
| RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT |
1.6% |
$42,979,889 |
0.2% - 3.0% |
| MAJOR SMALL & LARGE BOWEL PROCEDURES W CC |
1.4% |
$37,079,745 |
0.1% - 2.8% |
| CORONARY BYPASS W CARDIAC CATH |
2.4% |
$34,252,368 |
( 1.3%) - 6.1% |
| SIMPLE PNEUMONIA & PLEURISY AGE >17 W CC |
1.2% |
$33,344,451 |
0.7% - 1.7% |
| KIDNEY & URINARY TRACT INFECTIONS AGE >17 W CC |
3.2% |
$31,396,555 |
0.7% - 5.7% |
| OTHER CIRCULATORY SYSTEM DIAGNOSES W CC |
4.1% |
$30,651,010 |
1.9% - 6.3% |
| EPISTAXIS |
128.5% |
$30,088,687 |
( 122.1%) -379.0% |
| OTHER VASCULAR PROCEDURES W CC |
2.5% |
$30,063,492 |
0.2% - 4.7% |
| RESPIRATORY INFECTIONS & INFLAMMATIONS AGE >17 W CC |
2.1% |
$28,169,774 |
0.5% - 3.6% |
| EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS |
2.2% |
$26,528,257 |
0.2% - 4.3% |
| RENAL FAILURE |
1.7% |
$25,313,068 |
0.8% - 2.6% |
| SKIN GRAFT &/OR DEBRID FOR SKN ULCER OR CELLULITIS W CC |
9.3% |
$23,917,563 |
( 1.2%) - 19.8% |
| HEART FAILURE & SHOCK |
0.7% |
$23,512,534 |
0.2% - 1.1% |
| OTHER PERMANENT CARDIAC PACEMAKER IMPLANT |
1.7% |
$18,493,257 |
( 0.6%) - 4.0% |
| ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >17 W CC |
1.3% |
$16,854,136 |
0.7% - 2.0% |
| CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC |
1.9% |
$16,745,875 |
0.7% - 3.2% |
| Overall |
1.6% |
$3,925,879,291 |
1.4% - 1.8% |
|
|