What Is the Medicare National Correct Coding Initiative (NCCI)?

The National Correct Coding Initiative works under the center for Medicare and Medicaid Services (CMS). It is an initiative that was invented in order to promote the methodologies of National Correct Coding as well as the reduction of improper and inappropriate coding that can often result in inappropriate and error-ed payments of Medicaid claims and Medicare Part B coding claims.

The National Correct Coding Initiative for the Medicare program is different from the National Correct Coding Initiative for the Medicaid program. We will discuss both programs in great length in this article.

The Affordable Care Act of 2010 had asked CMS to make sure the system is notified maximum by September about the methodologies of the National Correct Coding Initiative (NCCI) that were compatible with the medical health system like Medicaid.

The Affordable Care Act also needed that all the Medicaid programs were well incorporated and compatible with the methodologies followed in the system while processing the Medicaid and Medicare as well.

Let’s have a look at the edits of the National Correct Coding Initiative.

Types of National Correct Coding Initiatives

There are two kinds of edits for NCCI. They are:

• The PTP edits of the National Correct Coding Initiative also known as the procedure-to-procedure edits are about the definite pairs of current procedural terminology (CPT) codes and the Healthcare common procedure coding system (HCPCS). Both systems are not supposed to be reported at once because of various reasons. The main purpose of the edits of PTP by NCCI is the prevention of the irrelevant payments which are imbursed because of erroneous codes and their combinations reported by other healthcare bodies.
• The Medically Unlikely Edits known as (MUEs) are to define the CPT/HCPCS codes according to the maximum usage age of units of service (UOS). This will be a provider and more like a guarantee to assure that the reports are filed under the circumstances when there was only one beneficiary and that to on an exclusive service at one time only.

Announcements of National Correct Coding Initiative

The replacement files of NCCI were announced by the CMS and were later on issued by CMS as well with a lot of changes in them. Some of the changes that occurred in the NCCI files are:

First-quarter, 2022 (replacement files) – The CMS issued the third installment of files for the PTP edits of NCCI for the files compiled in January 2022. The updated replaced files which were made public by Medicaid were made available on the page of edited files. This particular announcement was made on 3^rd February 2022.

• First-quarter, 2022 (replacement files) – The CMS issued another set of files for the PTP edits by NCCI according to the Medically Unlikely Edits (MUEs) for January 2022. These updated replacement files were also available on the edited file page. This announcement was made on 15 December 2021.
• Fourth-quarter, 2021, V2 (replacement files)- The CMS issued the set of files for the PTP edits or NCCI by October 2021. These updated replacement files were made public by Medicaid and were made available on the edited files section. This announcement was made on 4^th October 2021.
• First-quarter, 2021 (replacement files)- The CMS issued another set of files for the Medically Unlikely Edits (MUEs) for NCCI by January 1^st, 2021. These files were made public by Medicaid and were available for viewing on the edit’s files page. This announcement was made on 15^th December 2020
• Third-quarter of 2020 (replaced MUE files)- The CMS issued a new set of files for NCCI MUE OPH and NCCI MUE PRA in order to update the Medically Unlikely Edits (MUEs) for the Healthcare Common Procedure Coding System (HCPCS). The codes were G2079 and G2078 and were retroactively activated by July of 202. This public set of replacement files for Medicaid was made available on the edited files page and the announcement was made on 12^th August 2020.
• Second-quarter, 2020 (replacement files)- These files were about the Covid-19 health emergency declared for the public.

It was announced by the CMS that the services which were started on 6^th March 2020, Medicare were made liable to make payments to the Medicare telehealth services which were specially invented to assist the patients having broader and more severe circumstances.

• Even though the NCCI files were consistent in their data entry and fixed-date system. This consistency was marked and checked on the first day of every quarter that it worked and this is the reason the retroactive date was 1^st January 2020. Medicare payments for the expansion of telehealth and other related services had their dates of service beginning from the 6^th of March,2020.
• Physicians, health care professionals, hospitals, and healthcare providers were made liable to report all the services properly and correctly with the correct code even if the edits of OCE and NCCI were missing or absent. This announcement was made on the 14^th of May 2020 and later on, an updated announcement was made by CMS on the 3^rd of September, 2020.
• CMS later on, deleted all the PTP procedure-to-procedure edits which have a lot of retroactive dealing with radiopharmaceuticals by the 1^st of January,2020. This announcement was made on 28 February 2020.
• The codes G2062, and G2061 of the Healthcare Common Procedure Coding System (HCPCS) were replaced by codes G0231, G2030, and G2029, and these new codes became effective by the 1^st of January, 2020. This announcement was made on the 4^th of February, 2020.
• The CM also made a decision to keep a lot of edits that were previously in effect before January of 2020 and deleted the PTP edits for the current procedural terminology (CPT) by January 2020. This announcement was made on the 4^th of February, 2020.

The states were advised to align their medical and healthcare system according to the National Correct Coding Initiative and its edited files which were said to be available at a very secure portal other than to use them publicly from the available files on the website.

 The states were also asked to make sure that they as well as the vendor companies that they use are aligned with the policies and edits of NCCI and Medicaid in order to check the future claims made by the Medicaid claimants.

The manual revision of NCCI

The annual revision of the Medicaid NCCI policy was made available on the reference webpage and it became effective on the 1^st of January, 2022.

The older versions of the same manual are also available at the NCCI Medicaid Manual Archive which can be contacted for further information and older versions.

The annual revision of the Medicaid NCCI technical guidance manual was made public on 28^th February 2021 and is available for general viewing on the reference documents page.

These revision guides or manuals of different parts of NCCI became effective from the 1^st of January, 2020. The CMS also made it clear that the states do not have to submit different estimates of the savings which were obtained while applying different NCCI methodologies on the final payment reimbursements.

However, it is possible if a state wants to estimate the savings for their internal audit purpose, then the state is liable to consult with the NCCI MUE/ PTP savings and edit guidance for state Medicaid agencies. This is again available in the reference documents made public on the NICCI Medicaid website.

The requests for deactivations

The Affordable Act’s section 6507 allows the state to use all the compatible and accessible NCCI methodologies while paying the applicable claims of Medicaid. If at any given point the state determines or concludes that the documents available have no feasibility under the umbrella of Medicaid NCCI edits, then the state is liable to send a request about the deactivation of that particular edit.

States are not required anymore to send the deactivation request of NCCI to the CMS regional offices. This procedure is also done immediately with the involvement of the regional offices of CMS.

Guidance for National Correct Coding Initiative

If you want to know how to use the National Correct Coding Initiative then for the CMS Medicaid web pages dedicated to NCCI, along with the procedural pages of Medicaid where they discuss and teach users about the Medically Unlikely Edits (MUEs) and the Medicaid Procedure-to-procedure edits (PTP). The NCCI program for Medicare is different from the NCCI initiative program for Medicaid, as discussed above.

Another aspect of NCCI is that the CMS does not participate directly in the national Medicaid enterprise hub calls (NMEH). If any state wants to have guidance regarding any of the programs or edits under the NCCI then they can get the information from the NCCI program available at the Medicaid website or the Medicare website.

Final Verdict

The National Correct Coding Initiative (NCCI) was created to assist the medical and health system as well as to reduce the ambiguities from the final payment reimbursements as well as stop the erroneous billing across the country.

The NCCI program has assisted a lot of individuals in the past and it will continue to do so as the system is very efficient and the updates are timely and precise – assisting the general public which is the reason behind its existence in the first place.