In Coding
Feb 5th, 2019
Call on AAPC Coder and NCCI code pair edits for support. Many procedures in the CPT® code book are designated “separate procedures,” but that doesn’t mean you can report those procedures separately in every case. First, you must consider other procedures performed during the same encounter. “Separate” Might Not Mean What You Think It Does ...
In CMS
Jan 18th, 2019
There has been ongoing debate about how to code complex repairs versus tissue transfers and rearrangements. Correct coding requires an understanding of the two surgical approaches. In the latest update to the National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services, the Centers for Medicare & Medicaid Services (CMS) clarifies its definition of these ...
In Billing
Oct 19th, 2018
A beginner’s guide to claims code editing logic. The U.S. healthcare system is highly complicated and extremely expensive. There are many layers between the provider of medical services and the payment for those services. This overly complex system leads to inefficiencies resulting in incorrectly paid claims and the need to spend even more time and ...
Avoid payer denials by ensuring your provider or supplier follows the rules for allowable MUE units. Understanding why Medically Unlikely Edits (MUEs) were established, how they are organized, and the criteria on which edit rationales are based may help medical coders and billers avoid denials or, at a minimum, properly resolve a denial. What Are ...
Sep 11th, 2018
Scrubbing is the best way to ensure your claims are clean of unbundling overpayments. A hospital finance department should not treat National Correct Coding Initiative (NCCI) edits as irrelevant to inpatient billing simply because payers don’t use the NCCI to edit inpatient claims before payment. Instead, hospitals should institute internal controls to ensure claims are ...