Georgia Did Not Pay Some Line Items on Medicaid Claims in Accordance with its Medicaid National Correct Coding Initiative Methodologies.

摘要

In January 1996, the Centers for Medicare & Medicaid Services (CMS) implemented the NCCI, a program that consists of coding policies and automatic computer edits. The NCCI's purpose is to promote correct Healthcare Common Procedure Coding System (HCPCS) coding of health care services provided to Medicare beneficiaries and to prevent Medicare payment for improperly coded services. The NCCI edits identify HCPCS codes for services that, under Medicare coding and payment policy, ordinarily should not be billed for the same patient on the same day (HCPCS code pairs). On September 1, 2010, CMS notified States that the Medicare NCCI methodologies were compatible with Medicaid. CMS therefore required the States to incorporate the NCCI edit methodologies into their Medicaid claims processing systems and to begin editing claims filed on or after October 1, 2010. In Georgia, the State agency administers the Medicaid program. The State agency implemented the Medicaid NCCI in the Georgia Medicaid Management Information System (GAMMIS), a computerized payment and information reporting system, effective November 1, 2010. (CMS had given an extension to the October 1st deadline.) The State agency contracted with its fiscal agent to implement the Medicaid NCCI.