Confronting NCCI/MUE Processes: Reduce Edits and Eliminate Obstacles - On-Demand

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Confronting NCCI/MUE Processes: Reduce Edits and Eliminate Obstacles - On-Demand

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Confronting NCCI/MUE Processes: Reduce Edits and Eliminate Obstacles - On-Demand

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Available ON-DEMAND

Presented on:
Thursday, February 1, 2018

Presented by:
Denise Williams, RN, COC
Valerie Rinkle, MPA

Level of Program:

Sponsored by:

National Correct Coding Initiative (NCCI) edits and Medically Unlikely Edits (MUE) can be a major stumbling block in the Medicare billing process, and addressing these edits can be a cumbersome task that requires in-depth research to determine their root causes and effective resolutions. Confusion surrounding accountability for edit resolution can lead to delays with accounts receivable and lost revenue. And if facilities don’t familiarize themselves with payer policy changes for 2018, their billing and appeals processes stand to become even more complex.

During this 90-minute webinar, expert speakers Denise Williams, RN, COCand Valerie A. Rinkle, MPA, will demystify NCCI edits and MUEs as well as the process for resolving those edits. They will walk attendees through which edits can be appealed, why edits should be appealed, and how facilities can create processes for billing and coding departments to manage edits both proactively and retrospectively. Listeners will learn how to manage accountability for edits and implement best practices to effectively address edits across departments. The webinar will also include a review of 2018 policy changes and NCCI Manual updates. Case studies and real-life examples will demonstrate how different types of edits work and what policies can be effective in resolving those edits.

At the conclusion of this program, participants will be able to:

  • Define different types of NCCI edits and MUEs, and explain what they mean and why they matter
  • Develop and implement processes to fix common edits and reduce the overall volume of NCCI edits and MUEs
  • Recognize which NCCI edits and MUEs can be appealed and communicate the reason for appeal
  • Explain the root causes of common edits
  • Assess how edits might impact cost reporting and rate setting
  • Create best practices for dealing with edits and protecting revenue integrity

Who Should Listen? 

  • HIM managers and directors
  • Coding staff
  • Coding managers and directors
  • Revenue cycle managers and directors
  • Revenue integrity staff
  • Billing staff
  • Internal auditors
  • Denials and appeals staff
  • Finance staff
  • Reimbursement staff


  • Explain different types of edits and why they matter
    • NCCI edits
    • MUEs
  • Navigate CMS regulations to determine how they apply to NCCI edits and MUEs
    • Identify key CMS documents
    • Interpret CMS guidance
  • Discuss 2018 NCCI policy changes and implications
    • Chapter-by-chapter revisions
    • Highlight new codes and modifiers applicable to 2018 edit processes
  • Examine the root causes of edits to determine effective resolution techniques
    • Case studies
    • Real-life examples
    • Best practices
  • Evaluate the appeals process and its impact on rate setting
    • Considerations prior to billing
    • Process improvements
  • Assess how edits will be handled and moved through the work queue
    • Identify which departments should be involved in each stage of the process
    • Delegate specific responsibilities to proactive and retroactive processes


  • A decision tree for PTP edits


Continuing Education

American Health Information Management Association (AHIMA)
(Live + On Demand) - This program has been approved for 1.5 continuing education units for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor. (Ability to claim CEU’s for this webinar expires on: 1/31/19)

(Live + On Demand) - This program has the prior approval of AAPC for 1.5 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor. (Ability to claim CEH’s for this webinar expires on: 1/31/19)

Meet the Speaker

Denise Williams, RN, COC

Denise Williams, RN, COC, is senior vice president of the revenue integrity division and compliance auditor at Revant. She has more than 30 years of healthcare experience, including a background in multiple areas of nursing. For the past 20 years, Williams has been in the field of coding and reimbursement and has performed numerous E&M, OP surgical, ED, and observation chart reviews from the documentation, coding, compliance, and reimbursement perspectives. She serves as a contributing author to articles published in HCPro’s APC Insider and Briefings on APCs and is a nationally recognized speaker on various coding and reimbursement topics.

Valerie A. Rinkle, MPA

Valerie A. Rinkle, MPA, is a lead regulatory specialist and instructor for HCPro's Revenue Integrity and Chargemaster Boot Camp®, as well as an instructor for HCPro’s Medicare Boot Camp®—Hospital Version and Medicare Boot Camp®—Utilization Review Version. Rinkle is a former hospital revenue cycle director and has over 30 years in the healthcare industry, including over 12 years of consulting experience in which she has spoken and advised on effective operational solutions for compliance with Medicare coverage, payment, and coding regulations.

Webinar system requirements and program materials: 
To fully benefit from the webinar experience, please note you will need a computer equipped with the following:

Browser: Microsoft Internet Explorer 6 or later, Firefox, Chrome, or Safari, with JavaScript enabled 
Internet: 56K or faster Internet connection (high-speed connection recommended) 
Streaming: for audio/video streaming, Adobe Flash plug-in or Safari browser on iOS devices 

Prior to the webinar, you will receive an email with detailed system requirements, your login information, presentation slides, and other materials that you can print and distribute to all attendees at your location. 

No problem. The On-Demand version is now available. Use it as a training tool at your convenience—whenever your new or existing staff need a refresher or need to understand a new concept. Play it once or dozens of times. A $259 value! 

Participation in the webinar is just $259 per site. All materials must be retrieved from the Internet. 

Call your customer service representative toll-free 800-650-6787 or email if you have questions.