Follow the correct edit to promote payment and avoid denial. By Samantha Prince, BSHCM, COC, CPC, CPMA National Correct Coding Initiative (NCCI) edits for Medicare and Medicaid are not the same. If you’re following Medicare edits for Medicaid claims, you may have claims denying inappropriately. That’s missed revenue you could capture by applying the correct ...
Correct coding relies on understanding the edit tables and what the columns mean. By Ellen Hinkle, CPC, CPC-I, CPMA, CRC, CEMC, CFPC, CIMC It’s important to understand how the National Correct Coding Initiative (NCCI) affects medical coding and provider reimbursement. The Centers for Medicare & Medicaid Services (CMS) implemented this initiative in 1996 to promote ...
Feb 1st, 2016
Medically unlikely edits add restrictions to these codes. The American Medical Association (AMA) focused on prolonged services for 2016 CPT®. New codes were created and guidelines have been updated. Take note, and apply the changes when reporting these evaluation and management (E/M) services. Report Initial Prolonged Service Once, per Day Although medically unlikely edits (MUEs) ...
Dec 9th, 2015
Medicare claims processing systems contain edits that identify exact duplicate claims and suspect duplicate claims. Duplicate claims are counterproductive and costly, and they can get you into hot water with your Medicare administrative contractor (MAC): Too many billing errors (of any nature) may result in your MAC imposing program integrity actions against your practice. So ...
In Billing
Aug 6th, 2014
You can improve the turnaround time it takes to get claims paid by avoiding this common billing taboo: Don’t report the same procedure code on multiple lines to account for units of service. There’s a more efficient billing method that will help your correctly coded claims sail through adjudication. The keys to success are Medically Unlikely Units (MUE) and modifiers. MUEs ...