What are the OCE edits?
The OCE is an editing system created and maintained by CMS to process outpatient facility claims. The OCE edits identify incorrect and improper coding of these claims. The National Correct Coding Initiative (NCCI or CCI) was developed by CMS to promote consistent and correct coding methodologies.
What is an outpatient Code Editor?
I/OCE Purpose & Background The Integrated Outpatient Code Editor (I/OCE) software combines editing logic with the new APC assignment program designed to meet the mandated OPPS implementation. The software performs the following functions when processing a claim: Edits a claim for accuracy of submitted data.
What is non opps Medicare?
Certain services (for example, physical therapy, diagnostic clinical laboratory) are excluded from Medicare’s prospective payment system for hospital outpatient departments. These services are exceptions paid under fee schedules and other prospectively determined rates.
How many OCE edits are there?
Within the OCE are over 50 OCE edits, which determine whether a specific code is payable under the hospital OPPS. Many of the CCI edits are included in the OCE edits.
What is PTP coding edits?
Since 1996 the Medicare NCCI procedure to procedure (PTP) edits have been assigned to either the Column One/Column Two Correct Coding edit file or the Mutually Exclusive edit file based on the criterion for each edit.
What are the two major types of coding edits?
There are two basic types of code edits: the Correct Coding Initiative (CCI), and the Medically Unlikely Edits (MUE). Each performs a different function.
What is a grouper edit?
Outpatient editing The Medicare Home Health grouper includes the applicable OCE and NCCI edits, and a set of edits specifically designed to ensure correct coding & billing for Home Health claims. Editors available for other types of outpatient and professional claims include: • Medicare Renal Dialysis Facilities.
What is APC payment rate?
APC Payment Rate means CMS’ hospital outpatient prospective payment system rate. The APC payment rate is specified in the Federal Register notices announcing revisions in the Medicare payment rates.
How are opps services paid?
OPPS services are paid: services are paid using a status indicator methodology. A status indicator is assigned to every HCPCS code to identify how the service or procedure described by the code would be paid under the OPPS. Each HCPCS codes is assigned an APC and APC status indicator.