Final answer:
The Medicaid NCCI methodologies consist of four components: Procedure-to-Procedure edits, Medically Unlikely Edits, Add-on Code edits, and Modifiers, which help ensure correct billing and reduce improper payments.
Step-by-step explanation:
The Medicaid National Correct Coding Initiative (NCCI) methodologies are designed to prevent improper payments when submitting multiple healthcare procedures or services for the same patient on the same day. There are four main components to the Medicaid NCCI methodologies which are:
- Procedure-to-Procedure edits, which evaluate pairs of codes to check for services that are not reasonably performed together.
- Medically Unlikely Edits (MUEs), which assess the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single day.
- Add-on Code edits, which ensure that certain procedures are not reported without a primary procedure.
- Modifiers that are used to ensure that the reporting of services is accurate and not duplicative.
These components work together to minimize issues such as moral hazard, adverse selection, and unnecessary service provision in the fee-for-service structure of Medicaid prior to expansions under the Patient Protection and Affordable Care Act (ACA or Obamacare).