You are on page 1of 8

Claim Denied

(No Appeal)
TimelyFiling
$ 7,849,569
MedicalNecessity
$ 2,516,508
NoAuthorization
$ 1,295,032
PartialAuthorization $ 750,766
InvalidAuthforPatien $ 336,270
Surgical Retained F#RFOs
Sponges
Instrument
Needles
Miscellaneous

23
1
3
7

Pharmacy
Order Entry Errors
Ordernotreceived
51
WrongFrequencyofD
47
Duplicateorderentry
20
WrongDose
20
OmissionDrug
19
OrdernotDiscontinue
13
AdditionalInstructions
13
WrongDrug
11
WrongPatient
3
WrongRoute(IVvsIn
2

RoomNotRead
DoctorNotReady
PriorProcedureTooL
PriorCaseAddOn
PriorCaseTooEarly
CaseStartEarly

Missed Start Times in Cath Lab


43
88
47
26
84
19

NJ Impact of Adverse Events


Additionallaboratoryt
283 NJ 2007
Additionalpatientmon
270
Physicaldisabilityor
185
Increasedlengthofsta
183
Majorsurgery
121
Transfertohigherlevel
91
Death
72
Minorsurgery
53
Otheradditionaltestin
38
System/processdelay
38
Tobedetermined
35
Hospitaladmission
23
Lossofbodilyfunctio
13

WrongTechnique
WrongTime
WrongDose
WrongRoute
Drugnotavailable
WrongForm
ExtraDose
UnauthoriedDrug
Omission

Medicatio
n Errors
Baseline
41
33
5
5
3
3
1
0
0

OrthopedicSurgery
GeneralSurgery
Neurosurgery
UrologicSurgery
Other

Type of Wrong Site or Patient Su


52
25
18
13
18

WrongBodyPartorSite
WrongPatientSurgery
WrongProcedure

Wrong Site or Patient Surgery


96
17
13

Wrongpatient
Wrongprocedure
Wrongside
Wrongpart

Wrong Site or Patient Surgery


34
39
298
60

Adverse Event Patient falls in New Jersey Hospitals


Falls2005
PatientRoom
103
Hallway
6
EmergencyDepartment
8
Radiology
1
ICU/CCU/TCU
1
TelemetryUnit
1
CardiacCatheterizationLabo
0
RehabilitationAreas
1
Other
3

Other
Lossofsensoryfuncti
Lossoforgan

13
10
4

Medicatio Medicatio
n Errors n Errors
6 months 18 months
25
5
13
16
1
2
1
0
5
4
0
0
3
2
2
1
2
0

Type of Wrong Site or Patient Surgery


JointCommissionDec5,2001

SSN
Name
DOB
Test
Doctor
Other

Lab Order
Errors
226
71
58
44
39
16

Type of
Quantity
test
Chemistry
22063
Hematology
5532
Urine
2292
Serology
1043
Bacteriology
673

Missing Billing Coding and Info


Pharmacy
76
Diagnosis
12
Treatmentch
11
Accounttype
6
Venipuncture
5
Other
6

Wrong Site or Patient Surgery


JointCommissionDec5,2001

Wrong Site or Patient Surgery

alls in New Jersey Hospitals


Falls2006 Falls2007
132
152
12
14
12
12
3
4
3
4
0
4
2
2
2
2
2
2

DrugUseVolumeandcosts
Drug
Cost/unit
UnitsUsed TotalCost($000)
A
180
361
65
B
250
160
40
C
950
347
330
D
90
389
35
E
75
267
20
F
560
89
50
G
1350
11
15
H
650
169
110
I
220
114
25
J
15
1333
20
K
56
1518
85
L
150
1367
205

Adverse Events
infection
Injury
Mycardial infarction
Deep vein thrombosis
Fall
Pressure Sores
Rash
Breathing Problems
Confusion
Dizziness
Drop in Blood Pressure
Nausea
Pain
Other responses
Other events
total

Medical Error
Pharmacy
Clinician
Nonmedical Error
Insurance or billing
Scheduling
Wrong Information
Prescription Delay
Test results delay
Behaviour/Communicati
Waiting time
Clinician disrespect
Staff disrespect
Felt rushed
Technician care
Other
Misunderstanding
Medical Care
Medication side effects
Clinician unhelpful
Scheduling
Ordering
Insurance Coverage
Missing documentation

Medication
management

New
Medications
0
0
0
1
1
0
0
1
1
1
3
2
9
37
0
56

Effects of Effects of
surgery
tests
Other
0
38
6
7
3
84
6
3
0
9
2
7
0
9
1
1
0
3
1
11
0
6
0
7
71
3
5
13
7
18
0
8
27
3
0
0
40
0
0
1
25
23
3
9
70
0
5
0
0
9
7
3
91
0
6
1
3
84
30
20
337
289
72
91

Patient Reported Errors


Discharge Delays
26
MD Related
12093
12
LTC
6287
14
Discharge Planning
6205
22
Trans-family
4482
7
Caregiver
2075
6
Consult
1762
6
MRI
360
2
Trans-vendor
323
1
Echo
215
49
Pharmacy
158
18
Labs
135
11
General
110
8
Ins/Financial
97
4
HUC Transcripts
81
2
6
112
71
15
11
7
4
3
1

Allergy Related
Ambiguous Order
Delayed Treatment
Duplicate Additive (TPN)
Dupliate Order
Duplicate Therapy
Illegible
Incomplete (TPN and chemotherapy)
Incomplete other
Ion implance (TPN)
Overfill (TPN)
Rate/volume (TPN)
Unnecessary dose or medication
Unordered medication
unstable
Wrong calculation
Wrong concentration
Wrong Dose
Wrong dose of additive
Wrong drug
Wrong drug Additive
Wrong duration of therapy
Wrong dosage form
Wrong Frequency
Wrong Patient
Wrong rate ofinfusion
Wrong Route of adminsitration
Wrong Schedule
Wrong volume
Wrong weight

Prescribing
Errors
55
5
3
18
13
12
16
174
7
25
53
35
7
29
60
11
17
355
30
28
3
9
59
81
10
9
22
40
4
6