Activating CCI Edits

Help Guide for NextGen® Enterprise PM 8

Select Mutually Exclusive Edits in the Claim Edit Library

Check √ the appropriate CCI Mutually Exclusive edits as needed. You can set the CCI Mutually Exclusive edits with a Severity level based on business practices. Mutually Exclusive Edit Example Parent topic: CCI Edits

Help Guide for NextGen® Enterprise PM 8

Set Up CCI Edits

In File Maintenance, select Libraries > Claim Edits > Claim Edits Libraries. Select the applicable claim edit library. The Claim Edit Library Maintenance window appears. Check the appropriate CCI bundling edits as needed. You can set the CCI bundling edits with a severity level based on business practices. Select System > Payers, and then select the applicable payer. The Modify Payer Information window appears. Select the Practice tab, and then the Libraries tab on the bottom of the window. Attach the claim edit library to the payer by selecting a library in the Claim Edit Library field. Select OK. Bundling CCI Edits CCI Bundling Anesthesia Edits CCI Bundling Lab Edits Parent topic: CCI Edits

Help Guide for NextGen® Enterprise PM 8

Activating CCI Edits

If you want to include CCI edits among your activated Claim Edits, then you can select all the CCI edits. Selecting only some of the CCI Edits is not a best practice, this enables improper coding combinations to be applied to generated claims. Parent topic: CCI Edits

Help Guide for NextGen® Enterprise PM 8

Select Mutually Exclusive Edits in the Claim Edit Library

Check √ the appropriate CCI Mutually Exclusive edits as needed. You can set the CCI Mutually Exclusive edits with a Severity level based on business practices. Mutually Exclusive Edit Example Parent topic: CCI Edits

Help Guide for NextGen® Enterprise PM 8

CCI Edits

The Centers for Medicare and Medicaid Services (CMS) developed the National Correct Coding Initiative (CCI) to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment in Part B claims. The coding policies developed are based on coding conventions defined in the American Medical Association's CPT Manual, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practice and review of current coding practice. The National Correct Coding Policy Manual and edits have been developed for application to services billed by a single provider for a single patient on the same date of service. The purpose of the Correct Coding Initiative (CCI) edits is to ensure that uniform payment policies and procedures are followed by all carriers. When services are accurately coded and reported by physicians proper payment can be guaranteed. Note: You must be licensed for CCI edit

Help Guide for NextGen® Enterprise PM 8

Claim Edits

This chapter includes information about the Claim Edits library and the various types of edits that can be applied to a claim during claim processing. This section includes: Claim Edits Library PQRI Edits CCI Edits Local Medical Review Policy ICD Diagnosis Edits Claim Edits Library PQRI Edits CCI Edits Local Medical Review Policy Parent topic: Setting Up Claims

Activating CCI Edits

Recommendations

Select Mutually Exclusive Edits in the Claim Edit Library

Set Up CCI Edits

Activating CCI Edits

Select Mutually Exclusive Edits in the Claim Edit Library

CCI Edits

Claim Edits

Activating CCI Edits

Select Mutually Exclusive Edits in the Claim Edit Library

Set Up CCI Edits

Activating CCI Edits

Select Mutually Exclusive Edits in the Claim Edit Library

CCI Edits

Claim Edits