Claim edits remain a significant challenge in hospital and ambulatory billing, often leading to reimbursement delays, denials, and increased rework. This session provides a clear and practical overview of key edit systems affecting outpatient claims, including OCE, NCCI, MUEs, PTP edits, add-on code requirements, and medical necessity rules. Through real-world examples, attendees will learn how these edits function, why they occur, and how accurate coding, documentation, and modifier usage support compliant claim submission. The presentation emphasizes the importance of cross-functional collaboration among billing, coding, clinical, and revenue cycle teams to resolve issues more efficiently. Participants will leave with actionable strategies and resources to reduce denials, improve compliance, and streamline revenue cycle performance.

This session offers 1 AHIMA CEU.