tci Part B Insider - 2016 Issue 15

CCI Edits: Some Medicaid Payers Aren't Properly Implementing CCI Edits, OIG Says

Look out: CMS to start ensuring that states adhere to CCI bundles more carefully. When you collect your Medicaid payments, you probably aren’t marveling at the massive overpayments that you’ve received—but the OIG seems to think that some practices are getting paid too much. The agency recently audited state Medicaid insurers’ adherence to implementing Correct Coding Initiative (CCI) bundles, and discovered that many state programs haven’t quite gotten the hang of returning claims with CCI denials. Background: Under the Affordable Care Act (ACA), all state Medicaid programs were required to implement CCI edits by Oct...

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