Billing by Revenue Code

FloridaData

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 / 2,342,757 / 2,303,416 / 1,815,872 / 1,321 / 1,773 / 165,125 / 14 / 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 / 12,211 / 100,778 / 582,335 / 377 / 32 / 944 / 13 / 11 / 11
33x TOTAL / PT / 65,524 / 553,627 / 3,052,810 / 1,945 / 34 / 5,577 / 12 / 10 / 10
32x / OT / 511,358 / 507,046 / 365,804 / 1,082 / 473 / 66,175 / 8 / 8 / 8
32x TOTAL / OT / 2,262,850 / 2,112,980 / 1,354,482 / 5,482 / 413 / 321,029 / 7 / 7 / 8
33x / OT / 3,430 / 30,660 / 160,425 / 232 / 15 / 459 / 7 / 7 / 6
33x TOTAL / OT / 21,995 / 171,698 / 838,584 / 1,309 / 17 / 3,080 / 7 / 6 / 6
32x / SLP / 91,034 / 83,661 / 58,334 / 595 / 153 / 11,526 / 8 / 8 / 8
32x TOTAL / SLP / 514,549 / 461,168 / 303,757 / 3,865 / 133 / 67,850 / 8 / 7 / 8
33x / SLP / 608 / 5,314 / 29,574 / 70 / 9 / 87 / 7 / 7 / 7
33x TOTAL / SLP / 4,219 / 36,373 / 182,312 / 418 / 10 / 560 / 8 / 7 / 7
32x / SN / 3,783,511 / 3,774,571 / 3,553,501 / 1,368 / 2,766 / 199,942 / 19 / 19 / 25
32x Total / SN / 18,756,684 / 18,017,154 / 14,916,306 / 7,029 / 2,668 / 1,057,741 / 18 / 18 / 21
33x / SN / 15,614 / 131,912 / 815,266 / 436 / 36 / 1,171 / 13 / 12 / 12
33x TOTAL / SN / 79,747 / 749,948 / 4,690,087 / 2,286 / 35 / 6,893 / 12 / 11 / 12
32x / MSW / 33,345 / 30,495 / 22,652 / 702 / 48 / 20,457 / 2 / 2 / 2
32x TOTAL / MSW / 189,842 / 173,221 / 123,828 / 3,887 / 49 / 110,762 / 2 / 2 / 2
33x / MSW / 220 / 1,945 / 11,125 / 94 / 2 / 150 / 1 / 1 / 2
33x TOTAL / MSW / 1,189 / 11,338 / 66,105 / 480 / 2 / 771 / 2 / 2 / 2
32x / Aide / 587,329 / 605,901 / 649,804 / 1,154 / 509 / 28,286 / 21 / 21 / 30
32x TOTAL / Aide / 4,083,485 / 4,051,088 / 3,922,425 / 5,974 / 684 / 194,131 / 21 / 21 / 26
33x / Aide / 3,919 / 21,900 / 107,537 / 193 / 20 / 281 / 14 / 10 / 10
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 / FL / $1,045,398,021 / $1,037,230,517 / 876,349,440 / 1,389 / 752,626 / 221,115 / 4,728 / 4,751 / 5,440 / 1,051,731,788
32x / 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 / FL / 5,122,173 / 42,956,538 / 263,610,811 / 451 / 11,357 / 1,237 / 4,141 / 3,596 / 3,850 / 5,290,438
33x / 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
FL / 50.0 / 127.9 / 244,175 / 340,900 / 4.7 / 6.1 / 7.5
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
FL / 3.1 / 0.6 / 2.5 / 64.7 / 20.0 / 4,302 / 28,290,114
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

Florida Medical Review Denials 4th QTR 2014

Denial Code / Denial Description / Claims / Submitted Charges / Denied Charges
NONE / NONE / 47 / 108,934 / 0
56900 / Auto Deny - Requested Records not Submitted / 95 / 372,361 / 372,361
5F011 / Physician's Plan of Care and/or Certification Present - No Signature / 3 / 4,203 / 4,203
5F012 / Physician's Plan of Care and/or Certification Present - Signed but Not Dated / 1 / 3,476 / 3,476
5F023 / No Plan of Care or Certification / 2 / 5,402 / 5,402
5F041 / Info Provided Does Not Support the medical necessity for This Service / 2 / 4,385 / 4,385
5FF2F / Face to Face Encounter Requirements Not Met / 61 / 173,126 / 173,126
5FNOA / Unable to Determine medical necessity of HIPPS Code Billed as Appropriate Oasis Not Submitted / 4 / 15,457 / 15,457
5T071 / Services Billed Were More Than Ordered / 1 / 3,529 / 351
5TF2F / Face to Face Encounter Requirements Not Met / 1 / 110 / 110

Florida Medical Review Denials 2014

Denial Code / Denial Description / Claims / Submitted charges / Denied Charges
NONE / NONE / 588 / $1,748,711 / 0
56900 / Auto Deny - Requested Records not Submitted / 230 / $835,244 / $835,244
5A031 / Skilled Observation Not Needed From Start of Care / 1 / $3,966 / $3,966
5A041 / Info Provided Does Not Support the Medical Necessity for This Service / 11 / $20,405 / $20,287
5A301 / Info Provided Does Not Support the Medical Necessity for Therapy Services / 88 / $301,987 / $153,090
5A401 / Info Provided Does Not Support the Medical Necessity for MSW Visits / 1 / $1,755 / $1,755
5ADSD / Dependent Services Denied (Qualifying Service Denied Medically) / 12 / $24,232 / $24,232
5CHG1 / MR HIPPS Code Change/Doc Contradicts MO Item(s) / 6 / $23,173 / $7,189
5CHG3 / MR HIPPS Code Change Due to Partial Denial of Therapy / 83 / $299,195 / $113,172
5DOW4 / Partial Denial Resulting in a LUPA / 20 / $60,010 / $50,517
5F011 / Physician's Plan of Care and/or Certification Present - No Signature / 11 / $31,356 / $31,356
5F012 / Physician's Plan of Care and/or Certification Present - Signed but Not Dated / 15 / $48,991 / $48,991
5F013 / Physician's Plan of Care and/or Certification Present - Signed but Dated Untimely / 2 / $4,382 / $4,382
5F023 / No Plan of Care or Certification / 6 / $18,504 / $18,504
5F041 / Info Provided Does Not Support the Medical Necessity for This Service / 4 / $8,006 / $8,006
5F301 / Info Provided Does Not Support the Medical Necessity for Therapy Services / 12 / $38,827 / $38,827
5FF2F / Face to Face Encounter Requirements Not Met / 286 / $882,388 / $882,388
5FNAR / Certification Contained Within the Documentation Submitted Does Not Include a Physician Narrative Statement De / 3 / $7,610 / $7,610
5FNOA / Unable to Determine Medical Necessity of HIPPS Code Billed as Approriate Oasis Not Submitted / 31 / $115,888 / $115,888
5FNOF / Incorrect OASIS Submitted / 2 / $3,438 / $3,438
5T011 / Physician's Plan of Care and/or Certification Present - No Signature / 1 / $3,233 / $3,233
5T070 / Visits/Supplies/DME Billed Not Documented/Not Documented As Used / 3 / $7,616 / $2,719
5T071 / Services Billed Were More Than Ordered / 10 / $38,213 / $13,052
5T072 / No Physician's Orders for Services / 6 / $24,249 / $7,445
5T073 / Orders Not Signed &/or Dated Timely (VOs) / 6 / $23,416 / $10,483
5T078 / Incomplete Physician's Orders / 3 / $10,880 / $6,517
5T099 / Billing Error / 5 / $10,938 / $2,396
5T99B / Billing Outside Period / 1 / $3,713 / $3,713
5TDSD / Dependent Services Denied (Qualifying Service Denied Technically) / 1 / $3,346 / $3,346
5TF2F / Face to Face Encounter Requirements Not Met / 11 / $36,225 / $36,225
5TTDR / Assessment, Measurement, and Documentation of Therapy Effectiveness Not Submitted in the Medical Record / 14 / $50,364 / $13,356
MRDWN / Medical Review Downcode / 2 / $7,407 / $2,683
1,475 / $4,697,668 / $2,474,010

Diabetes Incidence by County

County / Number of New Cases
Alachua County / 1384
Baker County / 154
Bay County / 1134
Bradford County / 225
Brevard County / 4507
Broward County / 10539
Calhoun County / 102
Charlotte County / 1382
Citrus County / 1407
Clay County / 1069
Collier County / 2128
Columbia County / 476
DeSoto County / 264
Dixie County / 127
Duval County / 5210
Escambia County / 2248
Flagler County / 522
Franklin County / 70
Gadsden County / 384
Gilchrist County / 119
Glades County / 97
Gulf County / 119
Hamilton County / 110
Hardee County / 189
Hendry County / 212
Hernando County / 1182
Highlands County / 755
Hillsborough County / 8249
Holmes County / 140
Indian River County / 1059
Jackson County / 379
Jefferson County / 125
Lafayette County / 59
Lake County / 2253
Lee County / 3775
Leon County / 1547
Levy County / 343
Liberty County / 54
Madison County / 146
Manatee County / 2245
Marion County / 2435
Martin County / 1046
Miami-Dade County / 15500
Monroe County / 583
Nassau County / 445
Okaloosa County / 1412
Okeechobee County / 274
Orange County / 5952
Osceola County / 1449
Palm Beach County / 9998
Pasco County / 3425
Pinellas County / 7578
Polk County / 3937
Putnam County / 623
St. Johns County / 1063
St. Lucie County / 1985
Santa Rosa County / 940
Sarasota County / 2851
Seminole County / 2726
Sumter County / 518
Suwannee County / 294
Taylor County / 151
Union County / 99
Volusia County / 4114
Wakulla County / 199
Walton County / 364

State Diabetes Billing

Bill Type / Diagnosis Category / 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 / 250 Diabetes Mellitus / FL / 106,407,900 / 109,629,759 / 139,506,411 / 1,155 / 92,128 / 16,434 / 6,475 / 6,714 / 9,190 / 190,206,376
32x Home Health / 250 Diabetes Mellitus / TOTAL / $523,046,464 / $515,467,953 / $543,045,711 / 6,334 / $82,578 / 122,192 / $4,281 / $4,285 / 45,013 / 195,626
33x Home Health / 250 Diabetes Mellitus / FL / 287,536 / 2,190,039 / 12,111,574 / 61 / 4,714 / 71 / 4,050 / 3,750 / 3,616 / 411,743
33x Home Health / 250 Diabetes Mellitus / TOTAL / $1,623,308 / $13,811,969 / $82,403,594 / 375 / $4,329 / 449 / $3,615 / $3,262 / $3,299 / 494