Understanding NCCI Edits and Avoiding Claim Denials

Insurance companies use many different methods and policies in determining claims processing based on correct coding guidelines and medical necessity. The Center for Medicare and Medicaid Services with the help of the AMA and specialty Societies created the National Correct Coding Initiative (NCCI) to promote National coding methodologies and control improper coding for appropriate reimbursement. Today there are multiple parts of the NCCI edits that all play a role in payment or denial of a Medicare claim, as well as many commercial insurance claims that have also implemented these edits in one form or fashion. With an understanding of the edits, and knowledge on how to apply them, frequently a denial is understood and can be corrected for timely reimbursement. This is critical for the revenue cycle of an insurance claim because there are timely filing limits set by the insurance carriers that allow corrections and reconsiderations for only a certain amount of time after the date of service for original filing date. This webinar will discuss the multiple files and documentation of the edits so the attendees can apply these edits at the time of billing and coding or in the stage of resolving denials.

Webinar Objectives

There are several different parts of the NCCI Edits so it is important to understand each part it knows which ones should be applied to a particular claim and if there is a need to alter a claim utilizing modifiers, codes, etc. It is sometimes difficult to know to where to turn when there is a question on how services or procedures should be coded, or what is considered bundled or unbundled. The NCCI edits are the most used group of edits used by insurance companies across the country to process and deny claims. CMS publishes these edits at no charge, and they are available to anyone on the cms.gov website

Webinar Agenda

• What are the NCCI Edits?
• How are the edits published?
• Understanding the NCCI Edit files
• Applying the edits to a claim
• Using the edits for denial resolution

Webinar Highlights

• Medicare claims processing manual references to NCCI edits
• Procedure-to-Procedure Edits
• Medically Unlikely Edits
• Add On Code Edits
• The Policy Manual
• Customizing and keeping up to date NCCI files
• Assignment of modifier 59 and other modifiers

Who Should Attend

Billers, coders, claims processors, denials management, reimbursement, collectors, managers, administrators, supervisors, payment posters, claim adjusters