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HCPCS Definitions
Using the HCPCS Code Sets
Question | Answer |
---|---|
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. |
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. |
DME | Durable medical equipment (DME) - reusable medical equipment such as walkers, wheelchairs, or hospital beds. |
DMEPOS | Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) - Durable Medical Equipment, Prosthetics, Orthotics, and Supplies |
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) |
LCD | Local Coverage Determination (LCD) - a determination as to whether the service is reasonable and necessary |
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. |
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. |
NCD | a determination as to whether the service is reasonable and necessary which sites statutory requirements |
Overcoding/upcoding | Overcoding/upcoding – Assigning a code specifically for the purpose of obtaining a higher level of payment |
Undercoding | Failure to assign codes to based on the care that was provided |
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. |
Carrier | private company that has a contract with Medicare to pay your physician and most other Medicare Part B bills (third party administrator) |