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Audit (A-04-13-06166)

Kentucky Did Not Pay Some Line Items on Medicaid Claims in Accordance With Its Medicaid National Correct Coding Initiative Methodologies

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The Kentucky Department of Medicaid Services (State agency) did not pay some line items in accordance with its Medicaid National Correct Coding Initiative (NCCI) methodologies on claims hospitals submitted from December 16, 2010, through December 31, 2012. The NCCI promotes correct coding of health care services provided to Medicare beneficiaries and prevents Medicare payment for improperly coded services. Overall, the State agency satisfied Federal and State requirements by implementing the Medicaid NCCI into the Kentucky Medicaid Management Information System (KYMMIS), a computerized payment and information reporting system, on schedule. However, the Medicaid NCCI edits did not prevent erroneous payments. The State agency made erroneous payments to providers totaling $109,000 ($84,000 Federal share).

The erroneous payments occurred because the fiscal agent did not ensure that Medicaid NCCI edits incorporated in KYMMIS approved only comprehensive HCPCS codes when they were reported with component codes (already included in the comprehensive code) for the same date of service.

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