NCCIs and MUEs: Solving Claims Edits

Live Webinar on:
Tuesday, January 31, 2017 
1:00-2:30 p.m. Eastern

Presented by:
Valerie Rinkle, MPA
Denise Williams, RN, COC, AHIMA ICD-10 Ambassador

Level of Program:
Intermediate

Claims returned with NCCI edits or medically unlikely edits (MUE) can easily be lost in the shuffle. Often, it’s not clear who is responsible for resolving an edit, leading to further delays with accounts receivable. Properly addressing edits requires research and action to fix the source while avoiding duplicated efforts. Often, specific steps are required when handling edits from each of a facility’s payers.

Join expert speakers Denise Williams, RN, COC, and Valerie A. Rinkle, MPA, as they walk listeners through the different types of edits, which edits can be appealed and why, and processes for reducing edits on the front end. Listeners will learn best practices to manage accountability for edits as well as keep appeals and research on track. There will also be case studies and examples that illustrate different types of edits and common scenarios.

At the conclusion of this program, you will be able to:

• Explain different types of NCCI edits and MUEs and what they mean
• Recognize which NCCI edits and MUEs can be appealed and why they should be appealed
• Identify root causes of common edits
• Create systems to fix common edits and reduce overall volume of NCCI edits and MUEs
• Describe process improvements and best practices for handling edits and protecting revenue integrity

Agenda

• Understanding different types of edits and how they’re used
  • NCCI edits
  • MUEs
• Locating CMS information on NCCI edits and MUEs
  • Key CMS documents
  • Operationalizing CMS guidance
• What edits can be appealed and why they should be appealed—even if it won’t result in a higher payment
  • Appealing edits
  • Case studies
  • Best practices
• Identifying and fixing root causes to resolve edits once and for all
  • Case studies
  • Outreach and education
• Setting up different types of edits in the appeals process
  • Appeals process
  • Process improvements
• Process improvements for handling edits and moving them through the work queue
• Live Q&A

Meet the Speakers

Denise Williams, RN, COC, is senior vice president of the revenue integrity division and compliance auditor at Revant Solutions in Ft. Lauderdale, Florida. She has more than 30 years of healthcare experience, including a background in multiple areas of nursing. For the past 20 years, Williams has been in the field of coding and reimbursement and has performed numerous E&M, OP surgical, ED, and observation coding chart reviews from the documentation, compliance, and reimbursement perspectives. She serves as a contributing author to articles published in HCPro’s APC Insider and Briefings on APCs and is a nationally recognized speaker on various coding and reimbursement topics.
 
 
Valerie A. Rinkle, MPA, is a lead regulatory specialist and instructor for HCPro's Revenue Integrity and Chargemaster Boot Camp®, as well as an instructor for HCPro’s Medicare Boot Camp®—Hospital Version and Medicare Boot Camp®—Utilization Review Version. Rinkle is a former hospital revenue cycle director and has over 30 years in the healthcare industry, including over 12 years of consulting experience in which she has spoken and advised on effective operational solutions for compliance with Medicare coverage, payment, and coding regulations.

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