Medicare Compliance & Reimbursement
Connect With MAC for Certain NCCI Quandaries
Question: Which agency is most appropriate to contact if I have questions about an appeal related to a National Correct Coding Initiative (NCCI) claim denial? 星空入口Forum Participant Answer: It may seem confusing, but if you have a question about a specific claim, even if related to NCCI, you should direct it to your assigned Medicare Administrative Contractor (MAC), not an NCCI contractor. 鈥淭he NCCI Contractor is able to address general questions and concerns about the NCCI program and edits. Claim-specific inquiries must be directed to the MAC because NCCI edits are implemented by the MACs as part of routine claim processing. This includes appeals of NCCI-related denials,鈥� the Centers for Medicare & Medicaid Services (CMS) says on its website. Nuts and bolts: CMS developed and implemented NCCI to promote standardized 鈥� correct 鈥� coding of Medicare Part B claims. Its policies are based on coding conventions defined in the American Medical Association鈥檚 (AMA) CPT庐 code book, as well as 鈥渘ational and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices,鈥� according to the CMS website.
Medicare Compliance & Reimbursement
- ICD-10 Coding:
Boost Dx Coding With Sequencing Smarts
Caution: Lackluster sequencing can lead to claims denials. Diagnosis coding can be complicated and confusing. [...] - Fraud And Abuse:
DME, Genetic Testing Fraud Bring Big Enforcement Actions
Plus: Unnecessary therapy garners qui tam settlement. If you thought federal enforcers might slow the [...] - HIPAA Toolkit:
Create an Incident Response Team With These Tips
Add incident response to your annual HIPAA risk assessment. Securing your patients鈥� protected health information [...] - Reader Question:
Figure Out Which CMS-855 Best Applies to Your Organization
Question: At our rural practice, we have one doctor, and she wants to enroll as a [...] - Reader Question:
Connect With MAC for Certain NCCI Quandaries
Question: Which agency is most appropriate to contact if I have questions about an appeal related [...] - Industry Note:
HHS Extends the PHE for an 11th Go-Round
With COVID variants on the rise, the feds extended the public health emergency (PHE) 鈥� [...] - Industry Note:
Offer CMS Your Thoughts on a National Directory for Providers, Services
With consumers utilizing search engines more and more to find a clinician that provides the [...] - Industry Note:
See the Latest Turnaround on Medical Device Coverage and Authorization
The Centers for Medicare & Medicaid Services (CMS) offered its thoughts on the future of [...]
