New Mexico Data

Billing by Revenue Code

Cov. Revenue Units Code & Covered Covered Covered Prov. Cov. Units Bene perCov. Units per Cov. Units Descriptio Units Units Units Count per Prov. Count Bene Bene per Bene Bill Type n 2014H2 2014H1 2013H2 2014H2 2014H2 2014H2 2014H2 2014H1 2013H2 76,117 66,679 40,487 69 1,103 6,808 11 11 11 32x PT

32x Total PT 9,544,326 8,964,276 6,231,145 6,719 1,420 765,894 12 12 13 499 5,120 29,165 23 22 49 10 9 10 33x PT 33x TOTAL PT 65,524 553,627 3,052,810 1,945 34 5,577 12 10 10 20,722 17,634 11,014 55 377 2,922 7 7 8 32x OT 32x TOTAL OT 2,262,850 2,112,980 1,354,482 5,482 413 321,029 7 7 8 177 1,607 8,520 14 13 27 7 6 6 33x OT 33x TOTAL OT 21,995 171,698 838,584 1,309 17 3,080 7 6 6 6,291 4,337 3,161 53 119 824 8 7 7 32x SLP 32x TOTAL SLP 514,549 461,168 303,757 3,865 133 67,850 8 7 8 77 318 1,985 8 10 9 9 7 6 33x SLP 33x TOTAL SLP 4,219 36,373 182,312 418 10 560 8 7 7 147,142 129,326 93,672 70 2,102 9,329 16 15 17 32x SN 32x Total SN 18,756,684 18,017,154 14,916,306 7,029 2,668 1,057,741 18 18 21 842 7,261 48,534 28 30 64 13 10 12 33x SN 33x TOTAL SN 79,747 749,948 4,690,087 2,286 35 6,893 12 11 12 2,292 1,857 1,379 49 47 1,227 2 2 2 32x MSW 32x TOTAL MSW 189,842 173,221 123,828 3,887 49 110,762 2 2 2 12 131 805 7 2 9 1 2 2 33x MSW 33x TOTAL MSW 1,189 11,338 66,105 480 2 771 2 2 2 39,433 36,123 27,117 68 580 2,158 18 17 20 32x Aide 32x TOTAL Aide 4,083,485 4,051,088 3,922,425 5,974 684 194,131 21 21 26 254 1,906 10,192 8 32 14 18 12 12 33x Aide 33x TOTAL Aide 19,877 148,528 786,631 986 20 1,671 12 10 11

State Billing

Prov. Dis. Provider Provider Provider Prov. per Bene Prov. Dis. Prov. Dis. Prov. Dis. Claim Bill Disbursement Disbursement Disbursement Count Provider Count per Bene per Bene per Bene Count Type State 2014H2 2014H1 2013H2 2014H22014H2 2014H2 2014H2 2014H1 2013H2 2014H2 NM 42,394,955 36,995,531 25,228,274 70 605,642 10,042 4,222 3,995 4,195 46,023,515 32x 32x $4,841,899,1 $717,32 TOTAL $5,059,977,551 35 $3,763,963,099 7,054 0 1,151,240 $4,395 $4,374 $4,786 1,978,425 NM 257,909 2,318,299 15,000,448 30 8,597 70 3,684 3,079 3,645 279,119 33x 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) Number Number of of % Vague Median LOS Mean LOS Benes Claims % SSI % Diabetes Therapy 60.0 176.3 10,485 16,481 4.5 6.9 7.1 NM J11 60.0 222.9 1,223,805 1,986,639 3.4 7.9 7.1

% Benes with % Bene Disbursement % Wound Multiple with per Length of Care % Alzheimers % Hypertension Providers Discharge Bene Stay

NM 3.4 0.7 2.8 38.5 14.8 4,068 1,775,468

J11 3.2 0.7 4.8 49.6 20.6 4,158 257,495,130

Top MR Denials All States

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

New Mexico Medical Review Denials 4th QTR 2014

Denial Code Denial Description Claims Submitte Denied Charges d Charges NONE NONE 17 21,545 0 56900 Auto Deny - Requested Records not 1 1,988 1,988 Submitted 5A041 Info Provided Does Not Support the M/N 1 325 325 for This Service 5A301 Info Provided Does Not Support the M/N 1 6,075 3,859 for Therapy Services 5ADSD Dependent Services Denied (Qualifying 1 325 325 Service Denied Medically) 5FF2F Face to Face Encounter Requirements Not 4 8,702 8,702 Met MRDWN Medical Review Downcode 1 6,075 3,859

New Mexico Medical Review Denials 2014 Denial Denial Description Claims Submitte Denied Charges Code d charges NONE NONE 38 $76,606 $0 56900 Auto Deny - Requested Records not 5 $2,212 $2,212 Submitted 5A041 Info Provided Does Not Support the Medical 1 $325 $325 Necessity for This Service 5A301 Info Provided Does Not Support the Medical 1 $6,075 $3,859 Necessity for Therapy Services 5ADSD Dependent Services Denied (Qualifying 1 $325 $325 Service Denied Medically) 5CHG3 MR HIPPS Code Change Due to Partial Denial 1 $3,547 $353 of Therapy 5FF2F Face to Face Encounter Requirements Not 13 $34,030 $34,030 Met 5FNOA Unable to Determine Medical Necessity of 1 $112 $112 HIPPS Code Billed as Appropriate Oasis Not Submitted 5FNOF Incorrect OASIS Submitted 2 $7,004 $7,004 5TTDR Assessment, Measurement, and 1 $3,547 $353 Documentation of Therapy Effectiveness Not Submitted in the Medical Record MRDWN Medical Review Downcode 1 $6,075 $3,859 65 $139,858 $52,432

Diagnosed Diabetes Incidence

County Number of New Cases Bernalillo County 2233 Catron County 21 Chaves County 335 Cibola County 168 Colfax County 76 Curry County 206 De Baca County 12 Doña Ana County 790 Eddy County 281 Grant County 147 Guadalupe County 22 Harding County 5 Hidalgo County 29 Lea County 262 Lincoln County 114 Los Alamos County 83 Luna County 136 McKinley County 410 Mora County 27 Otero County 341 Quay County 55 Rio Arriba County 180 Roosevelt County 78 Sandoval County 451 San Juan County 603 San Miguel County 128 Santa Fe County 456 Sierra County 84 Socorro County 98 Taos County 136 Torrance County 78 Union County 19 Valencia County 311

State Diabetes Billing

Prov. Dis. Provider Provider Provider Prov. per Bene Prov. Dis. Prov. Dis. Prov. Dis. Claim Diagnosis Stat Disbursement Disbursement Disbursement Count Provider Count per Bene per Bene per Bene Count Bill Type Category e 2014H2 2014H1 2013H2 2014H2 2014H2 2014H2 2014H2 2014H1 2013H2 2014H2 250 N 3,431,295 3,044,902 2,568,832 63 54,465 827 4,149 3,722 3,964 3,788,126 32x Home Diabetes M Health Mellitus

250 32x Home Diabetes TOT Health Mellitus AL $523,046,464 $515,467,953 $543,045,711 6,334 $82,578 122,192 $4,281 $4,285 45,013 195,626 250 N 1,876 110,935 864,306 2 938 2 938 2,641 3,324 3,247 33x Home Diabetes M Health Mellitus 250 33x Home Diabetes TOT Health Mellitus AL $1,623,308 $13,811,969 $82,403,594 375 $4,329 449 $3,615 $3,262 $3,299 494