What computerized system is used by Medicare to prevent overpayments to providers?

The Correct Coding Initiative (CCI) is a computerized system utilized by Medicare primarily to prevent overpayments to healthcare providers by ensuring proper coding for medical services and procedures. This initiative consists of a set of coding policies that identify pairs of codes that should not be reported together, due to the nature of the services provided. By promoting correct coding practices, CCI helps to reduce fraud and abuse in the Medicare system, ensuring that payments are accurately aligned with the services rendered.

This initiative plays a crucial role in maintaining the integrity of Medicare billing and ensuring that claims are processed correctly. It helps coders and billing professionals adhere to coding guidelines and avoid submitting inaccurate claims that could result in overpayments to providers. Through regular updates, the CCI addresses changes in medical practices and coding trends, ensuring that the coding system stays current and reflective of best practices.

In contrast, the other options do not specifically focus on preventing overpayments through coding correction; for example, the Claims Adjustment System is more about adjusting claims rather than preventing incorrect billing upfront, while the Medicare Secondary Payer system pertains to coordination of benefits, and Cost-sharing assistance involves helping beneficiaries with their out-of-pocket costs, rather than directly preventing overpayments.