NCCIs and MUEs: Solving Claims Edits - On-Demand
Tuesday, March 28, 2017
Originally aired: Tuesday, January 31, 2017
Denise Williams, RN, COC
Valerie Rinkle, MPA
Level of Program:
Claims returned with NCCI edits or medically unlikely edits (MUE) can easily be lost in the shuffle. Often, it’s not clear who is responsible for resolving an edit, leading to further delays with accounts receivable. Properly addressing edits requires research and action to fix the source while avoiding duplicated efforts. Often, specific steps are required by payers when handling edits from each of a facility’s payers.
Join expert speakers Denise Williams, RN, COC, and Valerie A. Rinkle, MPA, as they walk listeners through the different types of edits, to which accounts they should be applied to, which edits can be appealed and why, processes for reducing edits on the front end, and how these edits impact cost reporting and rate setting. Listeners will learn best practices to manage accountability for edits as well as keep appeals and research on track. There will also be case studies and examples that illustrate different types of edits and common scenarios.
At the conclusion of this program, you will be able to:
- Explain different types of NCCI edits and MUEs and what they mean
- Understand reasons why NCCI edits should be applied to all accounts, not just Medicare and Medicaid accounts
- Recognize what NCCI and MUEs can be appealed and why they should be appealed
- Identify root causes of common edits
- Create processes to fix common edits and reduce overall volume of NCCI edits and MUEs
- Describe process improvements and best practices for handling edits and protecting revenue integrity
- Understand how edits may be impacting cost reporting and rate setting
Who Should Listen?
- HIM managers/directors
- Coding staff
- Coding managers/directors
- Revenue cycle managers/directors
- Revenue integrity staff
- Billing staff
- Internal auditors
- Denials and appeals staff
- Finance Staff
- Reimbursement Staff
- Understanding different types of edits and how they’re used
- NCCI edits
- Locating CMS information on NCCI edits and MUEs
- Key CMS documents
- Operationalizing CMS guidance
- What edits can be appealed and why they should be appealed—even if it won’t result in a higher payment
- Appealing edits
- Case studies
- Best practices
- Identifying and fixing root causes to resolve edits once and for all
- Case studies
- Outreach and education
- Setting up different types of edits in the appeals process
- Appeals process
- Process improvements
- Process improvements for handling edits and moving them through the work queue
- Live Q&A
(Live + On Demand) - This program has been approved for 1 continuing education unit 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: 1/31/2018)
(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: 1/31/2018)
Meet the Speakers
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