Type of Improper Payment | Estimated Dollars In Improper Payments (in millions) | Improper Payments as a Percent of Total |
---|---|---|
Documentation: | $10,846 | 46.76 |
Insufficient Documentation | 7,596 | 32.75 |
No Documentation | 3,250 | 14.01 |
Lack of Medical Necessity | 8,529 | 36.78 |
Incorrect Coding | 1,97 | 88.53 |
Noncovered or Unallowable Services | 1,219 | 5.26 |
Other | 620 | 2.67 |
Total | $23,192 | 100.00 |
Type of Provider | Types of Error (in millions) | Total | Percentage of Improper Payments | ||||
---|---|---|---|---|---|---|---|
Insufficent/No Documentation | Lack of Medical Necessity | Incorrect Coding | Noncovered/Unallowable Service | Remaining Errors | |||
Inpatient PPS | $1,040 | $3,301 | $900 | ($2) | $5,239 | 22.59 | |
Physician | 2,756 | 614 | 1,070 | $329 | 258 | 5,027 | 21.68 |
Home Health Agency | 1,684 | 1,935 | 31 | 3,650 | 15.74 | ||
Outpatient | 2,286 | 356 | 1 | 85 | 82 | 2,810 | 12.12 |
Skilled Nursing Facility | 1,056 | 1,365 | 3 | 2,424 | 10.45 | ||
Laboratory | 1,173 | 146 | (14) | 30 | 2 | 1,337 | 5.76 |
Subtotal | $9,995 | $7,717 | $1,957 | $444 | $374 | $20,487 | 88.34 |
Other Providers | 851 | 812 | 21 | 775 | 246 | 2,705 | 11.66 |
Total | $10,846 | $8,529 | $1,978 | $1,219 | $620 | $23,192 | 100.00 |
Percentage of Improper Payments | 46.76 | 36.78 | 8.53 | 5.26 | 2.67 | 100 |