AHA Coding Clinic® for HCPCS - 2010 Issue 4; FOR your INFORMATION
NCCI Edits and Medicaid
In early September, the Centers for Medicare & Medicaid Services issued initial guidance to state Medicaid directors implementing the National Correct Coding Initiative (NCCI) for Medicaid claims filed on or after Oct. 1, 2010, as required by the Patient Protection and Affordable Care Act. The guidance outlines the statutory requirements, methodologies, resources and funding for implementing the program, which applies coding policies and edits to services performed by the same provider for the same beneficiary on the same date of service. CMS has determined that the five methodologies currently in use for Medicare Part B are compatible methodologies for...
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Article Overview
This article explains early CMS guidance to state Medicaid directors on bringing National Correct Coding Initiative policies into Medicaid claims processing. It is relevant to Medicaid billing, compliance, and claims-editing workflows, and it summarizes the broad implementation framework, claim categories, and the main methodologies CMS identified for use in Medicaid.
Why This Topic Matters
The article helps readers understand how federal Medicaid guidance aligns claims editing with established CMS editing approaches. It is useful for organizations that process or review Medicaid claims and need awareness of the program scope, affected service settings, and implementation context.
What You Will Learn
- The purpose of CMS guidance on Medicaid NCCI implementation
- Which types of Medicaid claims and service settings are discussed
- What broad editing methodologies CMS identified for Medicaid use
- How the article frames the relationship between Medicaid claims and existing CMS editing approaches
Who Should Read This
- Medical coders
- Medicaid billing staff
- Compliance professionals
- Revenue cycle teams
- Claims processors
- Healthcare administrators
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