Avoid Fraud and Overpayment: AmeriVeri Emphasizes Importance of Using National Correct Coding Initiative to Reach 100% Clean Medical Claims

GREENWOOD, Ind., Nov. 2, 2015 /PRNewswire/ -- AmeriVeri (http://www.ameriveri.com/) provides insurance companies, third party administrators, and bill review companies with an efficient means to save money for clients, while also staying above board with respect to utilizing the National Correct Coding Initiative (NCCI) Edits used by Centers for Medicare and Medicaid Services (CMS). The company's proprietary SaaS solution delivers this benefit without the need to add new layers to existing processes. AmeriVeri adds tremendous – and measurable – value throughout the healthcare chain, promoting patient-centered care as well as ensuring that employers are paying only for medically appropriate and necessary claims.

"Employers and payers alike should understand the value of following NCCI guidelines," explains Steffeny Brewer CCS, AmeriVeri Director of Code Verification. "Non-compliance opens the doorway for fraud and overpayment. For employers, a payer that avoids NCCI edits may give the appearance of cost advantages, but any savings are wiped out by excess claims and the introduction of errors into patients' medical records. Our solution helps providers and payers utilize all available edits without adding unnecessary overhead to the already complex process of medical claims verification."

The NCCI was developed by the Centers for Medicare and Medicaid Services to reduce wasteful overpayment and encourage a consistent and accurate coding policy for procedures and services performed by the same provider on the same date of service. The initiative consists of procedure-to-procedure edits for healthcare providers, focusing primarily on pairings of HCPCS/CPT codes. NCCI guidelines undergo continual review to ensure all procedures are in line with current coding practices and relevant national and local policies.

A key facet of the NCCI is the elimination of unbundled services, wherein a provider is overpaid because they reported separate codes for one procedure when a single code should have accounted for the entirety of the work. The NCCI does include provisions for circumstances where unbundling is appropriate. The program also incorporates Medically Unlikely Edits (MUE) to earmark claims that are logically unlikely to be correct, such as the removal of more than one gall bladder or other age, gender and time considerations.

When the NCCI identifies an edit as optional, providers can add the -59 modifier to bypass the edit. However, the inappropriate use of this modifier is rampant. Research from the Comprehensive Error Rate Testing (CERT) program indicated that the -59 modifier was responsible for $770 million in errors in 2013.

Some payers and providers prefer to limit or entirely avoid the use of NCCI edits for the sake of simplifying verification, but this practice creates a perception of sloppiness at best, or fraud at worst. Given the proliferation of electronic medical records, there's no longer a reasonable excuse to skirt the value of represented savings and promotion of integrability of the medical claim, especially when AmeriVeri provides a seamless, effective process for utilization of the National Correct Coding Initiative.

AmeriVeri's line-by-line verification meets all the methodological benchmarks outlined by the CMS. The process catches an average of 2 or 3 errors per 100 lines – even after those same lines have passed through the payer's in-house error-catching mechanisms. With an unlimited verification capacity, AmeriVeri estimates the total applicable claims volume to exceed $680 billion per year.

AmeriVeri's proprietary SaaS solution does not replace any existing system; there's no software to install or learn. Instead, payers submit batches of medical claims via an encrypted SFTP transmission. AmeriVeri then returns a detailed report on all errors identified in one hour or less. Ultimately, the system empowers providers to focus on their patients, gives payers confidence in the integrity of medical code reporting, and saves employers money via accurate medical claims processing.

About AmeriVeri

AmeriVeri CR, LLC was founded in 2010, and fee options include Percentage of Savings and Flat Rate. The company is privately held with offices in Greenwood, Indiana, and Chicago, Illinois, and provides nationwide services in the Major Medical, Workers' Comp and Medicaid arenas.

Contact:

Martin Amberger, VP Operations 
888 354 8776 ext 704
Email

SOURCE AmeriVeri

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