EDITING CLAIMS

Question 1

their function is to identify conflicting code entries or other edits and inconsistencies before claims are submitted to payers

Answer 1

Software Programs

Question 2

identifies codes that are included (bundled) into another service

Answer 2

Medicare’s National Correct Coding Initiative (NCCI) System of Edits

Question 3

a feature of the NCCI system and are used to prevent overpayments of codes with an unlikely unit value
identify issues, such as code combinations

Answer 3

Medically Unlikely Edits (MUE)

Question 4

articles that explain the coverage circumstances of certain services, including indications and any limitations for the service and coding guidance

Answer 4

Medicare’s Local Coverage Determination (LCD) & National Coverage Determination (NCD)

Question 5

can be add-on services, so
a small or provider-owned organization may not have access to it and would solely on the billing and coding specialist to review and edit claims

Answer 5

Scrubbing applications

Question 6

Once the claim has been reviewed and edited as necessary, they are often further validated by who? as part of the claim submission process

Answer 6

Clearinghouse