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Effective October 1, 2010, requires states to incorporate compatible methodologies of the National Correct Coding Initiative (NCCI) used in the Medicare program within their respective Medicaid programs to curb improper coding and payments. Requires the Secretary of HHS to provide guidance to the states by September 1, 2010 to comply with this requirement and to submit a report to Congress that includes requisite notice to states by March 1, 2011.
Prior to January 2013, CMS issued final guidance pursuant to this provision via September 1, 2010 SMD letter, which was followed by a related information collection request in October of that same year. For more information on the NCCI, including updated FAQs, see the CMS webpage dedicated to this initiative.
2016
On Apr. 18, HHS’ Office of the Inspector General released a report that found that the effectiveness of the Medicaid NCCI edits was limited because some States had not fully implemented them and most did not use all of the edits correctly. OIG also said that States’ inconsistent implementation and use of the edits may reduce their ability to promote correct coding by providers and prevent improper Medicaid payments.
SEC. 6507. MANDATORY STATE USE OF NATIONAL CORRECT CODING INITIATIVE. Section 1903(r) of the Social Security Act (42 U.S.C. 1396b(r)) is amended— (1) in paragraph (1)(B)— (A) in clause (ii), by striking ‘‘and’’ at the end; (B) in clause (iii), by adding ‘‘and’’ after the semi-colon; and (C) by adding at the end the following new clause: ‘‘(iv) effective for claims filed on or after October 1, 2010, incorporate compatible methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) and such other methodologies of that Initiative (or such other national correct coding methodologies) as the Secretary identifies in accordance with paragraph (4);’’; and (2) by adding at the end the following new paragraph: ‘‘(4) For purposes of paragraph (1)(B)(iv), the Secretary shall do the following: ‘‘(A) Not later than September 1, 2010: ‘‘(i) Identify those methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) which are compatible to claims filed under this title. ‘‘(ii) Identify those methodologies of such Initiative (or such other national correct coding methodologies) that should be incorporated into claims filed under this title with respect to items or services for which States provide medical assistance under this title and no national correct coding methodologies have been established under such Initiative with respect to title XVIII. ‘‘(iii) Notify States of— ‘‘(I) the methodologies identified under subparagraphs (A) and (B) (and of any other national correct coding methodologies identified under subparagraph (B)); and ‘‘(II) how States are to incorporate such methodologies into claims filed under this title. ‘‘(B) Not later than March 1, 2011, submit a report to Congress that includes the notice to States under clause (iii) of subparagraph (A) and an analysis supporting the identification of the methodologies made under clauses (i) and (ii) of subparagraph (A).’’.
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