Using the HCPCS Code Sets
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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| CMN | Certificate of medical necessity (CMN) a form required by Medicare authorizing the use of certain durable medical items and equipment prescribed by a physician.
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| CCI | Correct coding initiative (CCI) - The CMS developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims.
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| DME | Durable medical equipment (DME) - reusable medical equipment such as walkers, wheelchairs, or hospital beds.
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| DMEPOS | Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) - Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
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| DMERCS | Durable Medical Equipment Regional Carriers (DMERCS) Durable Medical Equipment Regional Carriers. Private company that has a contract with Medicare to pay for DME to regional carriers (Part B)
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| LCD | Local Coverage Determination (LCD) - a determination as to whether the service is reasonable and necessary
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| MUE | Medically Unlikely Edits (MUEs) to reduce the paid claims error rate for Part B claims. An MUE for a HCPCS/CPT code is the maximum units of service that a provider would report for a single beneficiary on a single DOS.
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| MCM | Medically Unnecessary Edits (MUE) - is a unit of service (UOS) edit for a HCPCS/CPT code for the same provider, same beneficiary, and same date of service.
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| NCD | a determination as to whether the service is reasonable and necessary which sites statutory requirements
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| Overcoding/upcoding | Overcoding/upcoding – Assigning a code specifically for the purpose of obtaining a higher level of payment
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| Undercoding | Failure to assign codes to based on the care that was provided
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| ABN | Advance Beneficiary Notice is a notice that a doctor or supplier should give a Medicare beneficiary to sign when the doctor or supplier believes that Medicare will not pay for a particular service.
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| Carrier | private company that has a contract with Medicare to pay your physician and most other Medicare Part B bills (third party administrator)
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