McKesson Edits

NFBarner

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Does anyone have any information on the McKesson edits? Are they different from the CCI edits? I know Medicare and some insurance companies follow CCI, but not all. If so, where do you get information on McKesson or do they create specific edits for each client? Thanks!
 

sp485

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Mkesson...

Mkesson is cliet specific. They do their best to follow all local and federal mandates, however coding is sometimes interpretive. They follow the rules of that specific client while maintaining a high level accuracy in the coding world. Hope this helps.
 

NFBarner

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Thanks for the reply. I guess my question is if we get a denial for an insurance company that uses McKesson, can I use the Medicare CCI edits to prove that something is not bundled or does McKesson and their client insurance company decide on their own edits? If so, can we access those edits?
 

scorrado

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I was told that it is next to impossible to fight an insurance company that uses McKesson edits. I have personally tried a few times with no success and just found out recently at a seminar that I am not the only one who has had no luck with this. I used everything I could think of - CCI, Medicare EOB's showing how they pay, and CPT info. The speaker at the seminar I went to was very knowledgeable and she had no insight on this either. Like we dont have enough to keep up with and now we have McKesson edits!
 

kevbshields

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McKesson edits use their own logic. Sometimes that follows CCI, sometimes it's far more stringent. Because much of the reconsideration of a claim is done manually, the review folks on the payer sides still rely on that faulty McKesson logic--regardless of knowledge or data to the contrary. My advice, rely on "authority" like AMA, AMA's CPT Assistant and related tools. CCI really has very little effect on what third parties consider bundled.

I wish you both luck.
 
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