Image of male nurse pushing senior woman in a wheelchair in nursing facility

The Medicaid program could save tens of millions of dollars each year by applying Medicare’s National Correct Coding Initiative and thus eliminating improper payments to nursing homes and other providers, according to recommendations of a report released by the HHS Office of Inspector General last week.

Only 7 of 49 state Medicaid agencies that responded to a 2003 survey by the OIG reported that they use CCI edits in processing claims. The CCI include edits aimed at preventing payment for services by a provider on the same day for the same beneficiary. While use of the CCI edits is mandatory under Medicare, state Medicaid agencies are not required to use then.

A review of claims data for 2001 found that 39 states’ Medicaid programs paid $57 million for services involving the second code in a CCI code pair, the services for which CCI usually does not allow payment. This led the OIG to conclude that in 2001, as much as $54 million was paid by these states’ Medicaid agencies for services that would have been denied, had the CCI not been applied. Only 6%, or the remaining $3 million, would have been appropriate, according to the OIG report.

The OIG further recommended in the report that the Centers for Medicare & Medicaid Services encourage states to explore the use of CCI edits.