Health Information Management

Pay-per-view: NCCI logic could lead to no payment for claims including comprehensive APCs

APCs Insider, December 11, 2015

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Providers need to be careful when reporting multiple services with status indicator J1 on the same claim, as NCCI logic could result in no payment for any of the reported comprehensive APC (C-APC) services.
 
Typically, when multiple J1 procedures or services appear on the same claim, the procedure with the highest rank according to CMS is assigned to the C-APC. Certain code combinations of J1 services will also lead to a complexity adjustment to a higher-paying C-APC.

 

Continue reading "NCCI logic could lead to no payment for claims including comprehensive APCs" on HCPro’s website. Subscribers to Briefings on APCs have free access to this article in the December issue. 



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