ED Coding and Reimbursement Alert

CMS has made it easier for physicians and other providers to bill properly - and be paid promptly - for the services provided to Medicare beneficiaries
 
On its Web site, CMS has posted the automated edits used to identify questionable claims and adjust payments to reflect what would have been paid had the claim been correctly filed. The edits, known as the National Correct Coding Initiative (NCCI), identify pairs of services that normally cannot be billed by the same physician for the same patient on the same day. The NCCI also promotes uniformity in interpreting payment policies among contracted Medicare claims processors.
 
The NCCI edits, previously available only on a paid subscription basis, comprise two sets of edits:
 
1. Comprehensive/component edits identify code pairs that should not be billed together because one service inherently includes the other.
 
2. Mutually exclusive edits identify code pairs that, for clinical reasons, are unlikely to be performed on the same patient on the same day (e.g., a mutually exclusive edit might identify two different types of testing that yield equivalent results).
 
Users can sort the edits by procedural code or effective date. The new Web page also includes links to documents that explain the edits, the NCCI Policy Manual for Part B Medicare Carriers, Medicare Carriers Manual, and the NCCI Question and Answer page.
 
The NCCI edits are posted at http://cms.hhs.gov/physicians/cciedits/default.asp.
 
The Medicare Physician Fee Schedule Look-up can be found on the Physicians Resource Page: http://cms.hhs.gov/physicians/default.asp.