Medicaid Alert - Attention: All Providers - Additional Correct Coding Edits

The Patient Protection and Affordable Care Act of 2010 (P.L. 111-148), as amended by the Health Care and Education Recovery Act of 2010 (P.L. 111-152), together referred to as the Affordable Care Act (ACA) required state Medicaid programs to be compliant with the National Correct Coding Initiative (NCCI) by March 31, 2011. DMA effectively implemented the Mandated NCCI Initiative on March 31, 2011, and is compliant with this mandate.DMA plans to implement additional correct coding guidelines to enhance our current claim processing system. These new correct coding guidelines and edits will be nationally sourced by organizations such as the Centers for Medicare and Medicaid Services (CMS) and The American Medical Association (AMA). These edits will identify any inconsistencies with CPT, AMA, CMS and/or DMA policies and will deny the claim line.For example, the edits will ensure that:The appropriate procedure code is utilized based on age and gender of the patient. If a procedure code is submitted that requires a primary procedure code, DMA will verify that the primary procedure code has been submitted. Procedure codes are billed in the appropriate place of service as defined by AMA and/or CMS. For example, certain procedure codes are not permitted to be performed outside of an inpatient setting. Obstetric services including antepartum care, delivery, and postpartum care are billed appropriately according to CMS guidelines and DMA policy. The appropriate Evaluation and Management (E & M) codes are utilized for new patients and established patients. Certain services related to a surgical procedure are included in the payment of the global surgery package. These services would include E & M and related surgical procedures performed by the same physician for the same patient. Duplicate services are not submitted for the same provider, same patient for the same date of service. DMA will notify providers through the Medicaid Bulletin when these additional correct coding edits are being implemented.


Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.