| Service Billed to Carriers (HCPCS), DMERCs (HCPCS), FIs (Type of Bill), and QIOs (DRG) |
Medically Unnecessary Errors |
| Paid Claims Error Rate |
Projected Improper Payments |
95% Confidence Interval |
/
|
/
|
/
|
/
|
| MAJOR JOINT & LIMB REATTACHMENT PROCEDURES OF LOWER EXTREMITY |
1.3% |
$49,595,113 |
0.0% - 2.6% |
| ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >17 W CC |
12.7% |
$158,316,105 |
9.4% - 15.9% |
| Blood glucose/reagent strips (A4253) |
12.6% |
$123,825,802 |
10.4% - 14.8% |
| CHEST PAIN |
20.3% |
$121,037,136 |
15.4% - 25.3% |
| MEDICAL BACK PROBLEMS |
23.0% |
$84,998,443 |
15.1% - 31.0% |
| OTHER PERMANENT CARDIAC PACEMAKER IMPLANT |
6.8% |
$74,523,023 |
1.8% - 11.8% |
| NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 W CC |
6.5% |
$65,930,051 |
4.2% - 8.8% |
| CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH |
3.9% |
$65,512,515 |
( 1.2%) - 9.1% |
| OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >17 W CC |
10.9% |
$62,186,151 |
4.3% - 17.4% |
| SNF-inpatient or home health visits (Part B only) (22) |
5.0% |
$58,087,891 |
3.7% - 6.4% |
| HEART FAILURE & SHOCK |
1.4% |
$50,325,342 |
0.8% - 2.0% |
| CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O COMPLEX DIAG |
10.0% |
$49,040,207 |
4.9% - 15.1% |
| RENAL FAILURE |
2.8% |
$41,402,708 |
1.4% - 4.2% |
| ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >17 W/O CC |
19.9% |
$40,646,551 |
11.2% - 28.7% |
| DIABETES AGE >35 |
10.2% |
$39,826,790 |
5.6% - 14.8% |
| SYNCOPE & COLLAPSE W CC |
8.1% |
$37,904,118 |
4.0% - 12.1% |
| G.I. HEMORRHAGE W CC |
2.7% |
$36,151,588 |
1.1% - 4.3% |
| CHRONIC OBSTRUCTIVE PULMONARY DISEASE |
1.9% |
$35,445,636 |
0.9% - 2.9% |
| OTHER VASCULAR PROCEDURES W CC |
2.7% |
$32,706,248 |
( 0.2%) - 5.5% |
| Hospital-outpatient (HHA-A also)(under OPPS 13X must be used for ASC claims submitted for OPPS payment -- eff. 7/00) (13) |
0.2% |
$32,324,874 |
0.1% - 0.3% |
| Overall |
1.4% |
$3,491,819,051 |
1.3% - 1.5% |
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