Course Description:

National Correct Coding Initiative (NCCI) edits are used by the Medicare program, state Medicaid programs as well as some commercial insurance carriers and workers compensation carriers to combat abusive and fraudulent billing practices. This program will explain NCCI edits, the use of modifiers and what code(s) to append modifiers on the claim form. Coding and Billing staff at Hospitals are responsible for interpreting Medicare and Medicaid edits and determining when a modifier is appropriate.

This presentation will summarize the key Medicare NCCI edits as well as common modifiers and their application. We will review and summarize some of the issues surrounding the reporting of modifiers. Case examples will be utilized for the training. We will discuss the NCCI Edit manual and review the entity responsible for creating and maintaining the manual and what entities use the NCCI manual. We will define the edits and the methodology behind the edits, the history of the edits, when it was created and when it gets updated. We will go over how to locate the edits for Medicare, Medicaid, and Commercial payers. We will review some specific examples of using the NCCI edits and NCCI modifiers.

Incorrect usage of modifiers can lead to claim denials, delays in reimbursement, and compliance issues that could have serious financial consequences for healthcare providers. In this comprehensive webinar, we’ll break down the complexities surrounding Modifier 25, 59 and other crucial modifiers.

Learning Objectives:

• To have knowledge of the NCCI edit coding policy manual
• Identify how NCCI edits influence claim adjudication
• Know how proper modifier use can reduce claim rejections and boost reimbursement
• Learn how to correctly apply key modifiers and understand when their usage is appropriate under 2025 guidelines
• To be effective compliant with the latest updates from CMS and other regulatory bodies regarding modifier usage in your coding practices
• Learn the NCCI guidelines on the appropriate use of modifiers
• To Be able to apply the correct modifier(s) based on the specific circumstances
• Learn how to properly resolve NCCI edits including a breakdown of -59 and associated -X modifiers

Areas Covered in the Session:

• 2025 Updates on NCCI Edits and Modifiers
• NCCI Edits – General Trends
• NCCI Modifiers
• Modifier 24
• Modifier 25
• Modifier 59
• Modifier X {EPSU}
• ABN Modifiers
• Live Q&A session

Suggested Attendees:

• Physicians and Non-Physician Practitioners
• Medical Billers 
• Medical Coders
• AR Staff
• Office Managers
• Revenue Cycle
• Front Desk Staff
• Physicians in Private Practice 
• Qualified Health Care Professionals
• Auditors
• Nurses
• Practice Managers
• Medical Officers
• Compliance Officers
• Clinic Managers
• Insurance Company Claims Reviewers
• Insurance Payers
• Payment Policy Makers
• Denial Resolution Team