Region 10 Webinar: Learning to Love CMS Edits

    March 20, 2018
    12:00 PM - 1:00 PM
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    Session Description:

    The rate at which the transition from volume to value-based payments is occurring at different rates across markets and providers. Moving too quickly or too slowly risks losing money in fee-for-service contracts or value-based payments. Timing is everything, and varies in each market. In this session we will review electronic edits used by Medicare to include: Outpatient Code Editor (OCE), Medical Code Editor (MCE) and National Correct Coding Initiative (NCCI). Other topics include value and condition codes within the ANSI 837 standards.

    Session Objectives:

    1. Understand how CMS uses edits to ensure claims are valid for payment.
    2. Understand how coding compliance under NCCI can impact reimbursement.
    3. Understand how CMS uses value and condition codes to accomplish program objectives such as Advance Beneficiary Notification (ABN).


    Seth Avery has over 25 years of experience as a healthcare executive, serving as an auditor, consultant, Administrator and Chief Financial Officer (CFO). He has been certified by the American Academy of Professional Coders (AAPC) as a Certified Professional Coder (CPC). He has a BS from Campbell University, an MA from the University of New Mexico and a Juris Doctor from Texas A&M University. Seth is a 14-year veteran of the US Military. He is a frequent speaker at Healthcare Financial Management Association conferences and presents webinars providing education on various healthcare finance topics.