1. Surgical procedure in wrong setting (medically unnecessary): 5,421 ($88 million collected)
2. Excisional debridement (incorrectly coded): 6,092 ($66.8 million collected)
3. Cardiac defibrillator implant in wrong setting (medically unnecessary): 2,216 ($64.7 million collected)
4. Treatment for heart failure and a shock in the wrong setting (medically unnecessary): 6,144 ($33.1 million collected)
5. Respiratory system diagnoses with ventilator support (incorrectly coded): 2,102 ($31.6 million collected)
Here are the top four physician services with overpayments.
1. Pharmaceutical injectables (incorrect coding): 18,930 ($5.8 million collected)
2. Neulasta (medically unnecessary): 56 ($3.0 million collected)
3. Vestibular function testing (other error type): 13,805 ($1.4 million collected)
4. Duplicate claims (other error type): 11,165 ($1 million)
Read more about the RAC program and the evaluation report. Read a review of claim facts and corrective actions for an overpayment of excisional debridement.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.