Domain 2 correcting coding initiative, outpatient code editor

Flashcards by ediaz31, updated more than 1 year ago
Created by ediaz31 almost 7 years ago


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Resource summary

Question Answer
What does NCCI stand for? National Correct Coding Initiative
What does OCE stand for? The Outpatient Code Editor
What is NCCI? NCCI was developed by CMS to promote correct coding of healthcare services and prevention for inappropriate Medicare payment services
What is OCE? OCE is used to process Outpatient Prospective Payment System (OPPS) claims
What does NCCI control? NCCI controls improper payments on Medicare B part claims
What does NCCI edit? Automated edits are triggered on claims submitted by providers who bill for more than one service for the same beneficiary on the same date of services
Purpose for NCCI? NCCI edits, prevent improper payments when incorrect code combinations are reported, codes always consist of HCPCS and arranged in column one and two table coding edit file
What does the coding edit file table consist of? It contains two types of code pair edits, one type contains a component service and the other is an integral part of the comprehensive service
What did CMS developed it's coding policies based on? American Medical Association CPT's manual, national and local policies and edits, coding guidelines developed by national societies, analysis of medical and surgical practices and review of current coding practices
What are MUEs? Medically Unlikely edits developed by CMS to reduce the paid claims error rate for part B claims
Do all HCPCS/CPT codes have an MUE? No
How many edits does OCE have? Over 50 OCE edits, which determine whether a specific code is payable under the hospital OPPS
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