National Correct Coding Initiative

Added: Dec 02, 2010 4:44 pm The Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) intends to issue a solicitation for the National Correct Coding Initiative (NCCI). The NCCI shall be responsible for maintaining current correct coding initiative (CCI) edits to control overpayment of Part B, where manipulation of coding leads to inappropriate, increased reimbursement. At a minimum, maintaining CCI, including updating the current edits with any recommended changes or comments and CPT (Current Procedural Terminology) additions, deletions, and revisions. The contractor shall also be responsible for 1) maintaining the Medically Unlikely Edits (MUEs) (Units-of-Service Edits) to reduce coding and clerical errors for Part B Practitioner and Hospital Outpatient claims and 2) assisting the Center for Medicaid, CHIP, and Survey & Certification (CMCS) and the States in meeting the requirements of section 6507 of the Patient Protection and Affordable Care Act (PPACA).

The NCCI shall be responsible for at a minimum: 1) maintain and further expand the current correct coding edits to ensure proper coding for Part B and Hospital Outpatient services, 2) enable CMCS and the States to meet the requirements contained in section 6507 of the PPACA, and 3) continues maintenance of the associated manuals and continuation of the ongoing tasks, such as education to the provider community, replying to correspondence, etc.

It is anticipated that a firm fixed price contract will be awarded with a base period plus 4 option years. This requirement is being solicited as a total small business set a-side. This announcement is not a request for proposal (RFP). CMS anticipates releasing a Request for Proposal in mid December of 2010 and it will be available on the Federal Business Opportunities (FedBizOpps) website. At this time, there are funding uncertainties concerning the Medicaid related NCCI activities. Due to funding limitations, the forthcoming solicitation may be limited to Medicare NCCI work only and/or may contain optional Medicaid related tasks.