Question: Match the coding and billing compliance tool to its description. Coding and Billing Compliance Tool Answer Description a. CMS transmittal Documents that provide the circumstances
Match the coding and billing compliance tool to its description.
Coding and Billing Compliance Tool | Answer | Description |
a. CMS transmittal |
| Documents that provide the circumstances under which a service, procedure, or supply is considered medically necessary |
b. Local coverage determination |
| Contains day-to-day operating instructions, policies, and procedures for Medicare |
c. Medically unlikely edit |
| Software that processes data for the Medicare hospital outpatient payment system pricing and audits facility claims data |
d. Medicare claims processing manual |
| Software that detects, and reports errors identified on Medicare inpatient claims |
e. Medicare code editor |
| The way CMS communicates policies and procedures for their payment systems manuals to the MACs |
f. National correct coding initiative |
| Documents that describe the circumstances under which medical supplies, services, or procedures are covered nationwide by Medicare |
g. National coverage determination |
| Edits that identify instances when two procedure codes should not be reported together on the same date of service |
h. Outpatient code editor |
| Edits that identify the maximum number of units of service that are allowable for a HCPCS code on a single date of service |
i. Procedure-to-procedure edit |
| Set of edits that promote correct coding practices to control improper coding and prevent inappropriate payments |
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