by Medical Billing | Jun 15, 2016 | Medicare payment basics
The edits contained in the Claims Editing Tool are designed to provide appropriate coding, and to assist in processing claims accurately and consistently. The member is not responsible and should not be billed for any procedures for which payment has been denied or...
by Lori | Oct 9, 2010 | Medicare payment basics
The CMS developed Medically Unlikely Edits (MUEs) to reduce the paid claims error rate for Part B claims. An MUE for a HCPCS/CPT code is the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date...
by Lori | Oct 9, 2010 | Medicare payment basics
The CCI edits are part of the Outpatient Code Editor (OCE) that edits all outpatient claims and assigns APCs for Outpatient PPS services. In the past, the Outpatient Code Editor (OCE) did not include CCI edits for the following: anesthesiology, evaluation, and...
by Lori | Oct 5, 2010 | Medicare payment basics
National Correct Coding Initiatives Edits The CMS developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. The CMS developed its coding...