There are a lot of insurance carrier guidelines and policies for how procedures and services should be coded, but most guidelines and policies are derived from the published CMS guidelines because they are available to the public.


Understanding CMS NCCI Edits and the Relative Value File


Insurance companies and Medicare all use some form of claims editing to process claims and determine the rules and guidelines of how procedures and services can be reported alone or in code combinations.  This involves not only the use of CPT codes, but also includes assigning appropriate modifiers and units for claims.  The CMS National Correct Coding Initiative and the Physicians Relative Value File are the free online tools that share this information from a Medicare perspective, and is used in some form by other insurance carriers to determine how and when a claim will be paid.

Session Highlights:
  • Understanding the 3 parts of the NCCI File
  • What information can I use from the Relative Value File
  • Defending coding scenarios by referencing the files
  • Customizing the files for easier use in you office
  • Determine when to use the file information for coding claims
  • What is an MUE?
  • Using the NCCI Policy Manual as a coding tool
Why Should You Attend?

Many people working in the medical coding and billing field have some idea of how to utilize the CMS NCCI edits and the Physicians Relative File and but if you are not using all of their pieces, you may be missing information that could assist in submitting clean claims for a smooth process and timely reimbursement.  These files are used by many insurance carriers, outside of Medicare, because it is available online and free to anyone.  This saves commercial insurance carriers from having to create correct coding policies and procedures themselves.

Who Should Attend?

The target audience is anyone who codes and bills for professional or fee for service claims, Coders, Billers, Physicians, Physician Assistants, Nurse Practitioners, Auditors, Collectors, Surgery Schedulers, Medical Assistants

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