| Carriers (HCPCS), DMERCs (HCPCS), FIs (Type of Bill), and QIOs (DRG) |
Other Errors |
| Paid Claims Error Rate |
Projected Improper Payments |
95% Confidence Interval |
/
|
/
|
/
|
/
|
| CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH |
3.8% |
$62,866,664 |
( 2.0%) - 9.5% |
| SNF-inpatient (including Part A) (21) |
0.3% |
$46,624,390 |
( 0.1%) - 0.7% |
| Special facility or ASC surgery-hospice (non-hospital based) (81) |
0.6% |
$28,711,732 |
( 0.4%) - 1.5% |
| OTHER PERMANENT CARDIAC PACEMAKER IMPLANT |
1.8% |
$20,287,723 |
( 0.9%) - 4.6% |
| HHA-outpatient (HHA-A also) (33) |
0.5% |
$19,994,154 |
( 0.2%) - 1.1% |
| NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 W CC |
1.5% |
$15,385,984 |
0.3% - 2.8% |
| PSYCHOSES |
5.0% |
$14,627,037 |
4.8% - 5.2% |
| Hospital-outpatient (HHA-A also)(under OPPS 13X must be used for ASC claims submitted for OPPS payment -- eff. 7/00) (13) |
0.1% |
$13,421,157 |
( 0.0%) - 0.1% |
| HEART FAILURE & SHOCK |
0.3% |
$12,369,246 |
( 0.0%) - 0.7% |
| CHEST PAIN |
1.9% |
$11,492,391 |
0.5% - 3.4% |
| LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR AGE >17 W/O CC |
10.9% |
$11,480,376 |
( 2.6%) - 24.3% |
| CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH & COMPLEX DIAG |
1.2% |
$10,692,016 |
( 0.5%) - 2.9% |
| SIMPLE PNEUMONIA & PLEURISY AGE >17 W CC |
0.4% |
$10,196,548 |
( 0.0%) - 0.8% |
| PRM CARD PACEM IMPL W AMI/HF/SHOCK OR AICD LEAD OR GNRTR PROC |
2.8% |
$9,629,869 |
( 1.0%) - 6.6% |
| ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >17 W CC |
0.7% |
$9,264,609 |
0.1% - 1.4% |
| OTHER KIDNEY & URINARY TRACT PROCEDURES |
2.1% |
$9,142,150 |
( 1.2%) - 5.4% |
| Als 1 (A0426) |
12.2% |
$8,478,967 |
8.2% - 16.2% |
| CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O COMPLEX DIAG |
1.7% |
$8,448,183 |
0.2% - 3.3% |
| SYNCOPE & COLLAPSE W CC |
1.7% |
$7,813,634 |
( 0.3%) - 3.6% |
| TRANSURETHRAL PROCEDURES W CC |
4.6% |
$7,155,616 |
( 4.4%) - 13.6% |
| Overall |
0.2% |
$559,291,202 |
0.2% - 0.3% |
|
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