Billing by Revenue Code

Texas Data

Billing by Revenue Code

Bill Type / Revenue Code & Description / Covered
Units
2014H2 / Covered
Units
2014H1 / Covered
Units
2013H2 / Prov.
Count
2014H2 / Cov. Units per Prov.
2014H2 / Bene
Count
2014H2 / Cov. Units per Bene
2014H2 / Cov. Units per Bene
2014H1 / Cov. Units per Bene
2013H2
32x / PT / 1,924,880 / 1,796,052 / 1,363,580 / 2,448 / 786 / 130,996 / 15 / 14 / 15
32x Total / PT / 9,544,326 / 8,964,276 / 6,231,145 / 6,719 / 1,420 / 765,894 / 12 / 12 / 13
33x / PT / 12,340 / 105,697 / 482,591 / 461 / 27 / 919 / 13 / 12 / 12
33x TOTAL / PT / 65,524 / 553,627 / 3,052,810 / 1,945 / 34 / 5,577 / 12 / 10 / 10
32x / OT / 380,884 / 368,059 / 255,246 / 1,886 / 202 / 44,535 / 9 / 9 / 9
32x TOTAL / OT / 2,262,850 / 2,112,980 / 1,354,482 / 5,482 / 413 / 321,029 / 7 / 7 / 8
33x / OT / 4,202 / 31,414 / 121,411 / 295 / 14 / 502 / 8 / 8 / 7
33x TOTAL / OT / 21,995 / 171,698 / 838,584 / 1,309 / 17 / 3,080 / 7 / 6 / 6
32x / SLP / 99,673 / 90,458 / 63,371 / 1,256 / 79 / 10,580 / 9 / 9 / 10
32x TOTAL / SLP / 514,549 / 461,168 / 303,757 / 3,865 / 133 / 67,850 / 8 / 7 / 8
33x / SLP / 817 / 6,756 / 27,226 / 77 / 11 / 86 / 10 / 8 / 8
33x TOTAL / SLP / 4,219 / 36,373 / 182,312 / 418 / 10 / 560 / 8 / 7 / 7
32x / SN / 5,300,803 / 5,178,237 / 4,821,060 / 2,600 / 2,039 / 229,031 / 23 / 23 / 26
32x Total / SN / 18,756,684 / 18,017,154 / 14,916,306 / 7,029 / 2,668 / 1,057,741 / 18 / 18 / 21
33x / SN / 16,241 / 152,705 / 848,382 / 597 / 27 / 1,253 / 13 / 12 / 15
33x TOTAL / SN / 79,747 / 749,948 / 4,690,087 / 2,286 / 35 / 6,893 / 12 / 11 / 12
32x / MSW / 30,181 / 28,743 / 24,413 / 1,338 / 23 / 17,820 / 2 / 2 / 2
32x TOTAL / MSW / 189,842 / 173,221 / 123,828 / 3,887 / 49 / 110,762 / 2 / 2 / 2
33x / MSW / 172 / 1,628 / 7,821 / 92 / 2 / 115 / 1 / 2 / 2
33x TOTAL / MSW / 1,189 / 11,338 / 66,105 / 480 / 2 / 771 / 2 / 2 / 2
32x / Aide / 1,169,462 / 1,171,523 / 1,171,304 / 1,963 / 596 / 40,401 / 29 / 28 / 33
32x TOTAL / Aide / 4,083,485 / 4,051,088 / 3,922,425 / 5,974 / 684 / 194,131 / 21 / 21 / 26
33x / Aide / 4,316 / 33,854 / 155,648 / 223 / 19 / 304 / 14 / 13 / 14
33x TOTAL / Aide / 19,877 / 148,528 / 786,631 / 986 / 20 / 1,671 / 12 / 10 / 11

State Billing

Bill Type / State / Provider
Disbursement
2014H2 / Provider
Disbursement
2014H1 / Provider
Disbursement
2013H2 / Prov.
Count
2014H2 / Prov. Dis.
per Provider
2014H2 / Bene
Count
2014H2 / Prov. Dis.
per Bene
2014H2 / Prov. Dis.
per Bene
2014H1 / Prov. Dis.
per Bene
2013H2 / Claim
Count
2014H2
32x Home Health / TX / 1,229,750,996 / 1,186,369,445 / 1,042,418,291 / 2,600 / 472,981 / 233,720 / 5,262 / 5,149 / 5,531 / 1,367,139,838
32x
Home
Health / TOTAL / $5,059,977,551 / $4,841,899,135 / $3,763,963,099 / 7,054 / $717,320 / 1,151,240 / $4,395 / $4,374 / $4,786 / 1,978,425
33x Home Health / TX / 5,476,515 / 48,046,552 / 250,597,556 / 602 / 9,097 / 1,287 / 4,255 / 3,690 / 4,237 / 6,123,891
33x
Home
Health / TOTAL / $28,577,805 / $245,998,844 / $1,482,608,228 / 2,344 / $12,192 / 7,422 / $3,850 / $3,361 / $3,695 / 8,214

Aggregate Length of Stay (LOS)

Median LOS / Mean LOS / Number
of
Benes / Number
of
Claims / % SSI / % Diabetes / % Vague
Therapy
TX / 178.0 / 408.3 / 250,777 / 496,526 / 3.0 / 13.7 / 2.5
J11 / 60.0 / 222.9 / 1,223,805 / 1,986,639 / 3.4 / 7.9 / 7.1
% Wound
Care / % Alzheimers / % Hypertension / % Benes with
Multiple
Providers / % Bene
with
Discharge / Disbursement per
Bene / Length of
Stay
TX / 2.4 / 1.1 / 8.4 / 58.4 / 28.0 / 4,926 / 95,580,151
J11 / 3.2 / 0.7 / 4.8 / 49.6 / 20.6 / 4,158 / 257,495,130

Top MR Denials All States

Rank / Denial Code / Denial Description / Number of Claims / Percentage of Claims Denied
1 / 5FF2F / Face to Face Encounter Requirements Not Met / 3,813 / 72.1
2 / 56900 / Auto Deny - Requested Records not Submitted / 496 / 9.4
3 / 5CHG3 / MR HIPPS Code Change Due to Partial Denial of Therapy / 256 / 4.8
4 / 5F041 / Info Provided Does Not Support the medical necessity for This Service / 154 / 2.9
5 / 5FNOA / Unable to Determine medical necessity of HIPPS Code Billed as Appropriate Oasis Not Submitted / 133 / 2.5
6 / 5A041 / Info Provided Does Not Support the medical necessity for This Service / 127 / 2.4
7 / 5F012 / Physician's Plan of Care and/or Certification Present - Signed but Not Dated / 99 / 1.9
8 / 5TF2F / Face to Face Encounter Requirements Not Met / 90 / 1.7
9 / 5F023 / No Plan of Care or Certification / 59 / 1.1
10 / 5F011 / Physician's Plan of Care and/or Certification Present - No Signature / 58 / 1.1

Texas Medical Review Denials 4th QTR 2014

Denial Code / Denial Description / Claims / Submitted Charges / Denied Charges
NONE / NONE / 823 / 1,637,121 / 0
56900 / Auto Deny - Requested Records not Submitted / 88 / 185,527 / 185,527
5A031 / Skilled Observation Not Needed From Start of Care / 1 / 1,956 / 1,956
5A041 / Info Provided Does Not Support the M/N for This Service / 85 / 152,523 / 150,471
5A301 / Info Provided Does Not Support the M/N for Therapy Services / 16 / 51,331 / 23,039
5ADSD / Dependent Services Denied (Qualifying Service Denied Medically) / 78 / 142,035 / 142,035
5AE39 / SN No Documentation to Exempt From Endpoint - Insulin Administration / 1 / 5,085 / 5,085
5AT10 / Doc Does Not Support Homebound Status / 1 / 3,167 / 623
5CHG1 / MR HIPPS Code Change/Doc Contradicts MO Item(s) / 10 / 20,324 / 2,402
5CHG3 / MR HIPPS Code Change Due to Partial Denial of Therapy / 16 / 57,489 / 20,106
5DOW4 / Partial Denial Resulting in a LUPA / 10 / 19,235 / 16,195
5F011 / Physician's Plan of Care and/or Certification Present - No Signature / 6 / 19,942 / 19,942
5F012 / Physician's Plan of Care and/or Certification Present - Signed but Not Dated / 35 / 67,228 / 67,228
5F013 / Physician's Plan of Care and/or Certification Present - Signed but Dated Untimely / 4 / 17,848 / 17,848
5F023 / No Plan of Care or Certification / 15 / 29,724 / 29,724
5F041 / Info Provided Does Not Support the M/N for This Service / 81 / 139,608 / 139,608
5FE39 / SN No Documentation to Exempt From Endpoint - Insulin Administration / 1 / 9,572 / 9,572
5FF2F / Face to Face Encounter Requirements Not Met / 1,251 / 2,578,280 / 2,578,280
5FNAR / Certification Contained Within the Documentation Submitted Does Not Include a Physician Narrative Statement De / 3 / 5,134 / 5,134
5FNOA / Unable to Determine Med Nec of HIPPS Code Billed as App Oasis Not Submitted / 62 / 125,689 / 125,689
5FNOF / Incorrect OASIS Submitted / 4 / 5,749 / 5,749
5FT10 / Doc Does Not Support Homebound Status / 1 / 1,761 / 1,761
5FT39 / SN No Endpoint to Daily (Realistic or Unrealistic) / 1 / 5,529 / 5,529
5T070 / Visits/Supplies/DME Billed Not Documented/Not Documented As Used / 2 / 3,870 / 3,559
5T071 / Services Billed Were More Than Ordered / 7 / 22,691 / 15,965
5T072 / No Physician's Orders for Services / 2 / 22,210 / 9,584
5T073 / Orders Not Signed &/or Dated Timely (VOs) / 3 / 10,366 / 4,370
5T078 / Incomplete Physician's Orders / 3 / 8,751 / 5,006
5TDSD / Dependent Services Denied (Qualifying Service Denied Technically) / 1 / 1,811 / 1,811
5TF2F / Face to Face Encounter Requirements Not Met / 5 / 9,528 / 9,528
5TNAR / Certification Contained Within the Documentation Submitted Does Not Include a Physician Narrative Statement De / 1 / 1,811 / 1,811

Texas Medical Review Denials 2014

Denial Code / Denial Description / Claims / Submitted charges / Denied Charges
NONE / NONE / 1,346 / $3,131,333 / $0
56900 / Auto Deny - Requested Records not Submitted / 196 / $487,485 / $487,485
5A031 / Skilled Observation Not Needed From Start of Care / 2 / $3,736 / $3,736
5A041 / Info Provided Does Not Support the Medical Necessity for This Service / 110 / $217,999 / $213,423
5A301 / Info Provided Does Not Support the Medical Necessity for Therapy Services / 108 / $391,935 / $199,994
5ADSD / Dependent Services Denied (Qualifying Service Denied Medically) / 102 / $200,776 / $200,776
5AE39 / SN No Documentation to Exempt From Endpoint - Insulin Administration / 1 / $5,085 / $5,085
5AT10 / Doc Does Not Support Homebound Status / 1 / $3,167 / $623
5AT49 / SN Single Visit (No Other Qualifying Service) / 2 / $3,521 / $3,521
5CHG1 / MR HIPPS Code Change/Doc Contradicts MO Item(s) / 14 / $33,515 / $4,630
5CHG3 / MR HIPPS Code Change Due to Partial Denial of Therapy / 105 / $395,940 / $158,272
5DOW4 / Partial Denial Resulting in a LUPA / 19 / $45,918 / $40,067
5F011 / Physician's Plan of Care and/or Certification Present - No Signature / 21 / $71,035 / $71,035
5F012 / Physician's Plan of Care and/or Certification Present - Signed but Not Dated / 44 / $92,689 / $92,689
5F013 / Physician's Plan of Care and/or Certification Present - Signed but Dated Untimely / 11 / $36,347 / $36,347
5F023 / No Plan of Care or Certification / 25 / $58,631 / $58,631
5F031 / Skilled Observation Not Needed From Start of Care / 1 / $1,402 / $1,402
5F041 / Info Provided Does Not Support the Medical Necessity for This Service / 102 / $179,832 / $179,832
5F070 / Visits/Supplies/DME Billed Not Documented/Not Documented As Used / 1 / $3,619 / $3,619
5F301 / Info Provided Does Not Support the Medical Necessity for Therapy Services / 11 / $37,013 / $37,013
5FE39 / SN No Documentation to Exempt From Endpoint - Insulin Administration / 1 / $9,572 / $9,572
5FF2F / Face to Face Encounter Requirements Not Met / 1,496 / $3,339,935 / $3,339,935
5FNAR / Certification Contained Within the Documentation Submitted Does Not Include a Physician Narrative Statement / 3 / $5,134 / $5,134
5FNOA / Unable to Determine Medical Necessity of HIPPS Code Billed as App Oasis Not Submitted / 82 / $171,003 / $171,003
5FNOF / Incorrect OASIS Submitted / 5 / $8,754 / $8,754
5FT10 / Doc Does Not Support Homebound Status / 1 / $1,761 / $1,761
5FT39 / SN No Endpoint to Daily (Realistic or Unrealistic) / 1 / $5,529 / $5,529
5FU39 / Valid Endpoint Given, But Not Realistic / 1 / $2,341 / $2,341
5T070 / Visits/Supplies/DME Billed Not Documented/Not Documented As Used / 6 / $16,118 / $13,537
5T071 / Services Billed Were More Than Ordered / 15 / $52,143 / $27,903
5T072 / No Physician's Orders for Services / 11 / $59,027 / $26,801
5T073 / Orders Not Signed &/or Dated Timely (VOs) / 14 / $49,398 / $19,419
5T078 / Incomplete Physician's Orders / 6 / $18,993 / $11,343
5TDSD / Dependent Services Denied (Qualifying Service Denied Technically) / 4 / $11,574 / $11,445
5TF2F / Face to Face Encounter Requirements Not Met / 7 / $16,565 / $16,565
5TNAR / Certification Contained Within the Documentation Submitted Does Not Include a Physician Narrative Statement / 1 / $1,811 / $1,811
5TTDR / Assessment, Measurement, and Documentation of Therapy Effectiveness Not Submitted in the Medical Record / 15 / $56,945 / $15,364
MRDWN / Medical Review Downcode / 2 / $5,643 / $1,246
3,893 / $9,233,224 / $5,487,643

Diagnosed Diabetes Incidence

Anderson County / 375
Andrews County / 89
Angelina County / 593
Aransas County / 185
Archer County / 59
Armstrong County / 15
Atascosa County / 242
Austin County / 184
Bailey County / 44
Bandera County / 143
Bastrop County / 434
Baylor County / 34
Bee County / 197
Bell County / 1603
Bexar County / 9369
Blanco County / 61
Borden County / 5
Bosque County / 140
Bowie County / 614
Brazoria County / 1496
Brazos County / 797
Brewster County / 63
Briscoe County / 13
Brooks County / 48
Brown County / 289
Burleson County / 131
Burnet County / 292
Caldwell County / 224
Calhoun County / 141
Callahan County / 95
Cameron County / 2091
Camp County / 88
Carson County / 44
Cass County / 256
Castro County / 52
Chambers County / 183
Cherokee County / 330
Childress County / 52
Clay County / 84
Cochran County / 22
Coke County / 28
Coleman County / 70
Collin County / 2933
Collingsworth County / 23
Colorado County / 146
Comal County / 604
Comanche County / 101
Concho County / 25
Cooke County / 253
Coryell County / 415
Cottle County / 14
Crane County / 25
Crockett County / 28
Crosby County / 50
Culberson County / 17
Dallam County / 36
Dallas County / 12871
Dawson County / 97
Deaf Smith County / 104
Delta County / 41
Denton County / 2830
DeWitt County / 167
Dickens County / 20
Dimmit County / 60
Donley County / 30
Duval County / 80
Eastland County / 139
Ector County / 807
Edwards County / 13
Ellis County / 786
El Paso County / 3942
Erath County / 207
Falls County / 139
Fannin County / 231
Fayette County / 171
Fisher County / 32
Floyd County / 48
Foard County / 12
Fort Bend County / 2702
Franklin County / 73
Freestone County / 149
Frio County / 95
Gaines County / 82
Galveston County / 1993
Garza County / 32
Gillespie County / 176
Glasscock County / 8
Goliad County / 53
Gonzales County / 130
Gray County / 155
Grayson County / 877
Gregg County / 819
Grimes County / 208
Guadalupe County / 691
Hale County / 211
Hall County / 29
Hamilton County / 61
Hansford County / 34
Hardeman County / 33
Hardin County / 343
Harris County / 21403
Harrison County / 440
Hartley County / 40
Haskell County / 45
Hays County / 697
Hemphill County / 23
Henderson County / 539
Hidalgo County / 2945
Hill County / 247
Hockley County / 134
Hood County / 331
Hopkins County / 241
Houston County / 188
Howard County / 213
Hudspeth County / 20
Hunt County / 519
Hutchinson County / 188
Irion County / 12