What is the Medicare National Correct Coding Initiative (NCCI)?
The Medicare National Correct Coding Initiative (NCCI) (also known as CCI) was implemented to promote national correct coding methodologies and to control improper coding leading to inappropriate payment. NCCI code pair edits are automated prepayment edits that prevent improper payment when certain codes are submitted together for Part B-covered services. In addition to code pair edits, the NCCI includes a set of edits known as Medically Unlikely Edits (MUEs). An MUE is a maximum number of Units of Service (UOS) allowable under most circumstances for a single Healthcare Common Procedure Coding System/Current Procedural Terminology (HCPCS/CPT) code billed by a provider on a date of service for a single beneficiary. Consolidated Billing | Skilled Nursing Facility
ResidentsSection 4432(b) of the Balanced Budget Act (BBA) requires Consolidated Billing (CB) for the Skilled Nursing Facility (SNF). The CB requirement essentially confers on the SNF the Medicare billing responsibility for the entire package of care that its residents receive, except for a limited number of specifically excluded services. For services and supplies furnished to a SNF resident covered under the Part A benefit, SNFs will no longer be able to unbundle services to an outside provider of services or supplies that can then submit a separate bill directly to Medicare. Instead, the SNF must furnish the services or supplies either directly or under an arrangement with an outside provider. The SNF, rather than the provider of the service or supplies, bills Medicare. Medicare does not pay amounts that are due to a provider of the services or supplies to any other entity under assignment, power of attorney, or any other direct payment arrangement. (See 42 CFR 424.73.) As a result, the outside provider of the service or supplies must look to the SNF, rather than to the beneficiary or Medicare, for payment. The SNF may collect any applicable deductible or coinsurance from the beneficiary. Most covered services and supplies billed by the SNF, including those furnished under arrangement with an outside provider, for a resident of a SNF in a covered Part A stay are included in the SNF’s bill to the Fiscal Intermediary (FI). Home Health Prospective Payment System Types of services that are subject to the home health consolidated billing provision include:
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MAC | Useful Links
Noridian FEE SCHEDULE Noridian JE Part B Provider Portal Medicare Fee Schedule Look up Tool Look up Tool help PDF HIC Prefixes & Suffixes Medicare Coverage - Enrollees GPCI Payment Review PDF |