AHA Coding Clinic® for HCPCS - 2003 Quarter 4; FOR your INFORMATION
CMS posts correct coding initiatives (CCIs) on the Internet
The Centers for Medicare & Medicaid Services (CMS) has posted on it’s Web site the automated edits used to identify questionable claims. The Web site also lists adjusted payments to reflect what the payment would have been if the claim were filed correctly. The CCI edits, known as the National correct coding initiative (NCCI), identify pairs of services that normally should not be billed by the same physician for the same patient on the same day. The NCCI also promotes uniformity among the contractors that process Medicare claims in interpreting Medicare payment policies. The NCCI includes two types...
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Article Overview
This article covers CMS’s online availability of National Correct Coding Initiative (NCCI) edit files, including how the edit spreadsheets are organized and updated, and the role these edits play in Medicare claims processing. It is relevant to physicians, other providers, and coding professionals who monitor CMS correct coding policy and claims-edit resources. The article also gives a high-level overview of the two general categories of NCCI edits and the types of policy sources used to develop them.
Why This Topic Matters
CMS edit files affect how Medicare claims are reviewed and processed, so understanding where the files come from, how often they are updated, and what general kinds of edits are included helps coding and billing staff keep track of current Medicare guidance.
What You Will Learn
- What CMS is making publicly available through its correct coding initiative resources
- How the NCCI edit files are generally organized and updated
- What broad categories of edit logic are included in the initiative
- What kinds of policy sources inform CMS correct coding guidance
- Who may find the NCCI resources useful for claims and coding review
Who Should Read This
- Physicians
- Other providers
- Medical coders
- Billing staff
- Compliance staff
- Revenue cycle professionals
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