HCISMod Report,,,,,,,,,,,,,
MEDICARE,,,,,,,,,,,,,
16.1.1 National - Summary by Outlier Claims for Outlier Payments - PPS,,,,,,,,,,,,,
Year: 2009,,,,,,,,,,,,,
( Denials Excluded / SCIC Included ),,,,,,,,,,,,,
"Thursday, March 10, 2011",,,,,,,,,,,,,
Paid HIPPS,Paid HHRG, All Prorated Non-RAP Episodes (claims) ,Outlier Prorated Non-RAP Episodes (claims),Outlier Ratio,HIPPS Payment,Outlier Payment,PPS Subtotal,Passthru DME,Passthru Orthotics & Prosthetics,Other,Total Medicare Payment,Wound Care Submitted Chrg (Bundled),Other Med/Surg Supplies Submitted Chrg (Bundled)
1AFK,C1F1S1,"134,547.00",1113,0.01,"$1,539,833 ","$1,468,527 ","$3,008,359 ",$0 ,$0 ,$0 ,"$3,008,359 ","$71,417 ","$137,014 "
1AFL,C1F1S2,"12,459.00",32,0,"$62,892 ","$25,071 ","$87,963 ",$0 ,$0 ,$0 ,"$87,963 ",$538 ,"$3,498 "
1AFM,C1F1S3,"27,244.00",52,0,"$137,882 ","$53,839 ","$191,721 ",$0 ,$0 ,$0 ,"$191,721 ","$4,968 ","$3,393 "
1AGK,C1F2S1,"143,426.00",937,0.01,"$1,608,126 ","$995,187 ","$2,603,313 ",$0 ,$0 ,$0 ,"$2,603,313 ","$53,678 ","$111,214 "
1AGL,C1F2S2,"20,931.00",52,0,"$132,694 ","$32,906 ","$165,600 ",$0 ,$0 ,$0 ,"$165,600 ","$1,416 ","$5,049 "
1AGM,C1F2S3,"51,069.00",132,0,"$345,802 ","$112,812 ","$458,614 ",$0 ,$0 ,$0 ,"$458,614 ","$13,319 ","$16,376 "
1AHK,C1F3S1,"22,333.00",237,0.01,"$466,855 ","$309,223 ","$776,078 ",$0 ,$0 ,$0 ,"$776,078 ","$17,361 ","$29,327 "
1AHL,C1F3S2,"3,003.00",9,0,"$26,525 ","$13,221 ","$39,746 ",$0 ,$0 ,$0 ,"$39,746 ",$431 ,$105 
1AHM,C1F3S3,"7,965.00",47,0.01,"$149,254 ","$46,343 ","$195,598 ",$0 ,$0 ,$0 ,"$195,598 ","$1,927 ","$4,438 "
1BFK,C2F1S1,"235,933.00",2306,0.01,"$3,993,540 ","$4,180,358 ","$8,173,897 ",$0 ,$0 ,$0 ,"$8,173,897 ","$161,803 ","$357,892 "
1BFL,C2F1S2,"13,864.00",65,0,"$161,553 ","$83,302 ","$244,855 ",$0 ,$0 ,$0 ,"$244,855 ","$3,950 ","$8,265 "
1BFM,C2F1S3,"31,017.00",104,0,"$258,580 ","$150,582 ","$409,162 ",$0 ,$0 ,$0 ,"$409,162 ","$3,497 ","$14,970 "
1BGK,C2F1S1,"334,085.00",2706,0.01,"$5,521,951 ","$4,550,318 ","$10,072,268 ",$0 ,$0 ,$0 ,"$10,072,268 ","$155,923 ","$261,634 "
1BGL,C2F1S2,"34,791.00",125,0,"$338,210 ","$104,011 ","$442,221 ",$0 ,$0 ,$0 ,"$442,221 ","$7,687 ","$11,983 "
1BGM,C2F1S3,"85,273.00",260,0,"$791,376 ","$347,154 ","$1,138,530 ",$0 ,$0 ,$0 ,"$1,138,530 ","$13,151 ","$25,969 "
1BHK,C2F3S1,"72,986.00",778,0.01,"$1,805,334 ","$1,265,637 ","$3,070,972 ",$0 ,$0 ,$0 ,"$3,070,972 ","$85,001 ","$98,669 "
1BHL,C2F3S2,"7,457.00",39,0.01,"$122,713 ","$45,552 ","$168,266 ",$0 ,$0 ,$0 ,"$168,266 ","$3,463 ","$3,745 "
1BHM,C2F3S3,"19,238.00",103,0.01,"$326,282 ","$133,457 ","$459,739 ",$0 ,$0 ,$0 ,"$459,739 ","$19,891 ","$8,242 "
1CFK,C3F1S1,"300,365.00",12351,0.04,"$26,713,620 ","$36,592,573 ","$63,306,193 ",$0 ,$0 ,$0 ,"$63,306,193 ","$952,217 ","$2,057,248 "
1CFL,C3F1S2,"9,325.00",176,0.02,"$503,032 ","$416,224 ","$919,256 ",$0 ,$0 ,$0 ,"$919,256 ","$14,578 ","$20,841 "
1CFM,C3F1S3,"20,519.00",394,0.02,"$1,273,700 ","$952,118 ","$2,225,818 ",$0 ,$0 ,$0 ,"$2,225,818 ","$76,050 ","$63,276 "
1CGK,C3F2S1,"503,508.00",18364,0.04,"$44,828,328 ","$66,769,945 ","$111,598,273 ",$0 ,$0 ,$0 ,"$111,598,273 ","$1,313,422 ","$2,516,193 "
1CGL,C3F2S2,"32,091.00",443,0.01,"$1,430,666 ","$1,064,157 ","$2,494,823 ",$0 ,$0 ,$0 ,"$2,494,823 ","$48,633 ","$73,281 "
1CGM,C3F2S3,"78,800.00",1201,0.02,"$4,239,842 ","$3,015,207 ","$7,255,049 ",$0 ,$0 ,$0 ,"$7,255,049 ","$111,238 ","$257,498 "
1CHK,C3F3S1,"197,507.00",6763,0.03,"$18,410,679 ","$19,378,978 ","$37,789,657 ",$0 ,$0 ,$0 ,"$37,789,657 ","$1,079,959 ","$1,435,729 "
1CHL,C3F3S2,"12,944.00",280,0.02,"$975,220 ","$618,420 ","$1,593,640 ",$0 ,$0 ,$0 ,"$1,593,640 ","$38,687 ","$64,086 "
1CHM,C3F3S3,"32,968.00",610,0.02,"$2,279,949 ","$1,619,862 ","$3,899,811 ",$0 ,$0 ,$0 ,"$3,899,811 ","$65,189 ","$120,010 "
2AFK,C1F1S1,"9,534.00",24,0,"$66,597 ","$33,069 ","$99,667 ",$0 ,$0 ,$0 ,"$99,667 ",$768 ,"$4,568 "
2AFL,C1F1S2,"6,569.00",13,0,"$46,049 ","$10,862 ","$56,911 ",$0 ,$0 ,$0 ,"$56,911 ",$146 ,"$1,999 "
2AFM,C1F1S3,"3,963.00",*,0,"$26,511 ","$6,854 ","$33,365 ",$0 ,$0 ,$0 ,"$33,365 ",$529 ,$272 
2AGK,C1F2S1,"20,758.00",75,0,"$250,102 ","$112,645 ","$362,747 ",$0 ,$0 ,$0 ,"$362,747 ","$4,151 ","$3,632 "
2AGL,C1F2S2,"14,087.00",37,0,"$106,124 ","$39,640 ","$145,764 ",$0 ,$0 ,$0 ,"$145,764 ","$3,147 ","$1,468 "
2AGM,C1F2S3,"8,924.00",22,0,"$84,972 ","$34,904 ","$119,876 ",$0 ,$0 ,$0 ,"$119,876 ","$1,234 ","$1,990 "
2AHK,C1F3S1,"8,355.00",32,0,"$104,035 ","$42,297 ","$146,331 ",$0 ,$0 ,$0 ,"$146,331 ","$3,092 ","$1,447 "
2AHL,C1F3S2,"5,934.00",31,0.01,"$103,400 ","$29,570 ","$132,970 ",$0 ,$0 ,$0 ,"$132,970 ","$1,935 ",$966 
2AHM,C1F3S3,"4,146.00",13,0,"$50,422 ","$17,267 ","$67,689 ",$0 ,$0 ,$0 ,"$67,689 ","$1,364 ",$497 
2BFK,C2F1S1,"28,631.00",83,0,"$254,331 ","$180,620 ","$434,952 ",$0 ,$0 ,$0 ,"$434,952 ","$1,682 ","$5,212 "
2BFL,C2F1S2,"18,690.00",40,0,"$100,918 ","$58,528 ","$159,447 ",$0 ,$0 ,$0 ,"$159,447 ","$1,501 ","$1,568 "
2BFM,C2F1S3,"10,412.00",29,0,"$88,091 ","$53,232 ","$141,323 ",$0 ,$0 ,$0 ,"$141,323 ",$366 ,$753 
2BGK,C2F2S1,"74,629.00",254,0,"$872,300 ","$432,404 ","$1,304,704 ",$0 ,$0 ,$0 ,"$1,304,704 ","$7,197 ","$12,385 "
2BGL,C2F2S2,"48,168.00",126,0,"$455,843 ","$218,393 ","$674,235 ",$0 ,$0 ,$0 ,"$674,235 ","$3,133 ","$5,413 "
2BGM,C2F2S3,"29,723.00",86,0,"$251,143 ","$114,992 ","$366,134 ",$0 ,$0 ,$0 ,"$366,134 ","$3,189 ","$5,735 "
2BHK,C2F3S1,"30,100.00",122,0,"$448,555 ","$185,366 ","$633,921 ",$0 ,$0 ,$0 ,"$633,921 ","$5,072 ","$10,872 "
2BHL,C2F3S2,"21,030.00",73,0,"$259,837 ","$109,454 ","$369,291 ",$0 ,$0 ,$0 ,"$369,291 ","$3,665 ","$1,523 "
2BHM,C2F3S3,"14,037.00",55,0,"$210,998 ","$62,872 ","$273,870 ",$0 ,$0 ,$0 ,"$273,870 ","$3,192 ","$7,055 "
2CFK,C3F1S1,"15,456.00",273,0.02,"$1,186,712 ","$1,042,577 ","$2,229,289 ",$0 ,$0 ,$0 ,"$2,229,289 ","$18,425 ","$36,990 "
2CFL,C3F1S2,"9,383.00",149,0.02,"$693,351 ","$525,512 ","$1,218,863 ",$0 ,$0 ,$0 ,"$1,218,863 ","$4,676 ","$14,226 "
2CFM,C3F1S3,"5,285.00",85,0.02,"$380,085 ","$328,504 ","$708,590 ",$0 ,$0 ,$0 ,"$708,590 ","$1,570 ","$8,761 "
2CGK,C3F2S1,"65,124.00",1111,0.02,"$5,057,246 ","$4,473,144 ","$9,530,390 ",$0 ,$0 ,$0 ,"$9,530,390 ","$46,300 ","$117,471 "
2CGL,C3F2S2,"40,957.00",466,0.01,"$2,250,265 ","$1,587,671 ","$3,837,936 ",$0 ,$0 ,$0 ,"$3,837,936 ","$37,321 ","$76,169 "
2CGM,C3F2S3,"24,722.00",320,0.01,"$1,540,538 ","$1,052,728 ","$2,593,266 ",$0 ,$0 ,$0 ,"$2,593,266 ","$23,182 ","$39,558 "
2CHK,C3F3S1,"43,925.00",755,0.02,"$3,598,004 ","$2,369,148 ","$5,967,152 ",$0 ,$0 ,$0 ,"$5,967,152 ","$65,566 ","$129,830 "
2CHL,C3F3S2,"29,868.00",425,0.01,"$2,149,756 ","$1,442,852 ","$3,592,608 ",$0 ,$0 ,$0 ,"$3,592,608 ","$41,226 ","$49,283 "
2CHM,C3F3S3,"19,770.00",266,0.01,"$1,384,100 ","$779,184 ","$2,163,284 ",$0 ,$0 ,$0 ,"$2,163,284 ","$25,365 ","$75,395 "
3AFK,C1F1S1,"132,945.00",1332,0.01,"$2,017,128 ","$2,885,225 ","$4,902,353 ",$0 ,$0 ,$0 ,"$4,902,353 ","$36,807 ","$165,676 "
3AFL,C1F1S2,"2,593.00",14,0.01,"$30,449 ","$22,461 ","$52,910 ",$0 ,$0 ,$0 ,"$52,910 ",$805 ,$223 
3AFM,C1F1S3,"6,604.00",46,0.01,"$118,115 ","$76,229 ","$194,344 ",$0 ,$0 ,$0 ,"$194,344 ","$1,032 ","$2,064 "
3AGK,C1F2S1,"180,866.00",2356,0.01,"$4,320,209 ","$4,710,071 ","$9,030,280 ",$0 ,$0 ,$0 ,"$9,030,280 ","$48,463 ","$208,150 "
3AGL,C1F2S2,"5,179.00",30,0.01,"$75,740 ","$66,584 ","$142,325 ",$0 ,$0 ,$0 ,"$142,325 ","$7,667 ",$595 
3AGM,C1F2S3,"14,006.00",120,0.01,"$328,670 ","$195,397 ","$524,067 ",$0 ,$0 ,$0 ,"$524,067 ","$4,095 ","$10,375 "
3AHK,C1F3S1,"60,767.00",792,0.01,"$1,699,929 ","$1,808,105 ","$3,508,034 ",$0 ,$0 ,$0 ,"$3,508,034 ","$35,312 ","$74,871 "
3AHL,C1F3S2,"1,642.00",16,0.01,"$50,653 ","$35,713 ","$86,366 ",$0 ,$0 ,$0 ,"$86,366 ",$134 ,"$3,304 "
3AHM,C1F3S3,"4,767.00",33,0.01,"$103,864 ","$51,490 ","$155,354 ",$0 ,$0 ,$0 ,"$155,354 ","$1,104 ","$2,229 "
3BFK,C2F1S1,"180,823.00",19757,0.11,"$32,819,586 ","$117,522,349 ","$150,341,935 ",$0 ,$0 ,$0 ,"$150,341,935 ","$131,036 ","$1,150,450 "
3BFL,C2F1S2,"2,601.00",92,0.04,"$219,525 ","$447,175 ","$666,700 ",$0 ,$0 ,$0 ,"$666,700 ","$3,366 ","$5,235 "
3BFM,C2F1S3,"6,608.00",264,0.04,"$741,866 ","$1,358,547 ","$2,100,412 ",$0 ,$0 ,$0 ,"$2,100,412 ","$4,811 ","$9,598 "
3BGK,C2F2S1,"331,570.00",42099,0.13,"$83,848,017 ","$267,010,396 ","$350,858,414 ",$0 ,$0 ,$0 ,"$350,858,414 ","$197,422 ","$2,118,490 "
3BGL,C2F2S2,"7,535.00",292,0.04,"$809,863 ","$1,438,605 ","$2,248,467 ",$0 ,$0 ,$0 ,"$2,248,467 ","$2,506 ","$26,007 "
3BGM,C2F2S3,"20,276.00",855,0.04,"$2,706,068 ","$4,374,748 ","$7,080,816 ",$0 ,$0 ,$0 ,"$7,080,816 ","$25,443 ","$73,909 "
3BHK,C2F3S1,"125,286.00",9004,0.07,"$20,725,601 ","$49,193,960 ","$69,919,561 ",$0 ,$0 ,$0 ,"$69,919,561 ","$118,914 ","$549,947 "
3BHL,C2F3S2,"3,251.00",96,0.03,"$313,274 ","$428,980 ","$742,253 ",$0 ,$0 ,$0 ,"$742,253 ",$840 ,"$4,756 "
3BHM,C2F3S3,"8,746.00",288,0.03,"$984,581 ","$1,239,290 ","$2,223,870 ",$0 ,$0 ,$0 ,"$2,223,870 ","$3,286 ","$25,468 "
3CFK,C3F1S1,"156,461.00",20868,0.13,"$45,802,544 ","$104,444,724 ","$150,247,268 ",$0 ,$0 ,$0 ,"$150,247,268 ","$1,153,874 ","$2,634,309 "
3CFL,C3F1S2,"1,883.00",136,0.07,"$403,496 ","$547,653 ","$951,148 ",$0 ,$0 ,$0 ,"$951,148 ","$11,215 ","$11,479 "
3CFM,C3F1S3,"4,445.00",302,0.07,"$980,467 ","$1,187,088 ","$2,167,555 ",$0 ,$0 ,$0 ,"$2,167,555 ","$18,035 ","$29,924 "
3CGK,C3F2S1,"346,922.00",52449,0.15,"$129,258,028 ","$295,260,350 ","$424,518,378 ",$0 ,$0 ,$0 ,"$424,518,378 ","$1,618,389 ","$4,654,094 "
3CGL,C3F2S2,"7,083.00",407,0.06,"$1,338,481 ","$1,692,619 ","$3,031,099 ",$0 ,$0 ,$0 ,"$3,031,099 ","$28,902 ","$99,154 "
3CGM,C3F2S3,"19,065.00",1129,0.06,"$4,058,765 ","$4,971,533 ","$9,030,299 ",$0 ,$0 ,$0 ,"$9,030,299 ","$70,095 ","$154,604 "
3CHK,C3F3S1,"286,810.00",25750,0.09,"$72,959,321 ","$106,986,863 ","$179,946,185 ",$0 ,$0 ,$0 ,"$179,946,185 ","$2,863,562 ","$5,543,926 "
3CHL,C3F3S2,"6,133.00",304,0.05,"$1,107,964 ","$924,458 ","$2,032,422 ",$0 ,$0 ,$0 ,"$2,032,422 ","$30,254 ","$234,996 "
3CHM,C3F3S3,"15,646.00",857,0.05,"$3,426,563 ","$3,193,142 ","$6,619,705 ",$0 ,$0 ,$0 ,"$6,619,705 ","$72,014 ","$127,224 "
4AFK,C1F1S1,"4,048.00",21,0.01,"$67,659 ","$29,668 ","$97,327 ",$0 ,$0 ,$0 ,"$97,327 ",$296 ,$911 
4AFL,C1F1S2,"3,516.00",15,0,"$59,287 ","$16,279 ","$75,565 ",$0 ,$0 ,$0 ,"$75,565 ",$122 ,$938 
4AFM,C1F1S3,"1,495.00",*,0,"$12,908 ","$2,437 ","$15,346 ",$0 ,$0 ,$0 ,"$15,346 ",$16 ,$9 
4AGK,C1F2S1,"10,302.00",101,0.01,"$369,631 ","$186,026 ","$555,657 ",$0 ,$0 ,$0 ,"$555,657 ","$1,914 ","$8,716 "
4AGL,C1F2S2,"8,181.00",49,0.01,"$173,809 ","$79,566 ","$253,375 ",$0 ,$0 ,$0 ,"$253,375 ","$4,718 ","$1,834 "
4AGM,C1F2S3,"3,809.00",23,0.01,"$98,408 ","$46,221 ","$144,629 ",$0 ,$0 ,$0 ,"$144,629 ","$1,167 ","$5,122 "
4AHK,C1F3S1,"1,574.00",17,0.01,"$68,017 ","$36,001 ","$104,018 ",$0 ,$0 ,$0 ,"$104,018 ","$1,232 ","$2,501 "
4AHL,C1F3S2,"1,323.00",*,0.01,"$37,233 ","$15,261 ","$52,494 ",$0 ,$0 ,$0 ,"$52,494 ",$5 ,"$2,021 "
4AHM,C1F3S3,672,*,0.01,"$19,786 ","$6,782 ","$26,567 ",$0 ,$0 ,$0 ,"$26,567 ",$170 ,$711 
4BFK,C2F1S1,"7,488.00",120,0.02,"$466,798 ","$532,657 ","$999,455 ",$0 ,$0 ,$0 ,"$999,455 ","$2,505 ","$2,649 "
4BFL,C2F1S2,"5,343.00",63,0.01,"$279,717 ","$315,868 ","$595,585 ",$0 ,$0 ,$0 ,"$595,585 ","$1,240 ","$2,599 "
4BFM,C2F1S3,"2,486.00",32,0.01,"$151,340 ","$145,528 ","$296,868 ",$0 ,$0 ,$0 ,"$296,868 ","$1,232 ",$578 
4BGK,C2F2S1,"30,847.00",607,0.02,"$2,744,834 ","$2,852,987 ","$5,597,821 ",$0 ,$0 ,$0 ,"$5,597,821 ","$8,525 ","$51,242 "
4BGL,C2F2S2,"21,340.00",273,0.01,"$1,286,441 ","$1,085,353 ","$2,371,794 ",$0 ,$0 ,$0 ,"$2,371,794 ","$4,567 ","$14,889 "
4BGM,C2F2S3,"9,769.00",136,0.01,"$654,096 ","$537,113 ","$1,191,209 ",$0 ,$0 ,$0 ,"$1,191,209 ",$970 ,"$7,194 "
4BHK,C2F3S1,"4,468.00",96,0.02,"$453,203 ","$325,581 ","$778,784 ",$0 ,$0 ,$0 ,"$778,784 ",$829 ,"$7,283 "
4BHL,C2F3S2,"3,329.00",65,0.02,"$335,717 ","$215,056 ","$550,773 ",$0 ,$0 ,$0 ,"$550,773 ","$5,681 ","$5,082 "
4BHM,C2F3S3,"1,722.00",32,0.02,"$171,867 ","$104,571 ","$276,438 ",$0 ,$0 ,$0 ,"$276,438 ",$990 ,$715 
4CFK,C3F1S1,"6,955.00",745,0.11,"$3,757,130 ","$4,082,155 ","$7,839,285 ",$0 ,$0 ,$0 ,"$7,839,285 ","$5,497 ","$43,062 "
Totals:,,,,,,,,,,,,,
,Non-LUPA,"5,637,399.00",249917,0.04,"$639,867,796 ","$1,204,246,569 ","$1,844,114,365 ",$0 ,$0 ,"($63,609)","$1,844,050,755 ","$11,911,569 ","$28,664,472 "
,LUPA,"607,886.00",0,0,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
,Grid,"6,245,285.00",249917,0.04,"$639,867,796 ","$1,204,246,569 ","$1,844,114,365 ",$0 ,$0 ,"($63,609)","$1,844,050,755 ","$11,911,569 ","$28,664,472 "