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.
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