Q&A: Applying NCCI edits to claims

Q: Do National Correct Coding Initiative (NCCI) edits apply to all claims or do they only apply to Medicare claims?

A: NCCI applies only to Medicare Part B claims (both institutional and professional claims) and to Medicaid claims. Because of CMS’ requirements concerning charges, and due to the use of charges in apportionment of costs, gross charges should be applied consistently to all patients—Medicare and others. NCCI edits should arguably be applied to all claims, because resolving the edits often results in removing or changing billed charges for a service.

For more information, see The Chargemaster Essentials Toolkit, Second Edition.