Health Information Management

Tip: Understand medically unlikely edits

APCs Insider, September 25, 2009

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CMS created medically unlikely edits (MUEs) to ensure that providers don’t report excessive units of service on Medicare Part B claims. However, MUEs continue to confuse hospitals.
 
These tips will help you make sense of MUEs:
  • Become familiar with MUEs that CMS has published
  • Verify whether your facility provided the number of units in question
  • Be prepared to resubmit edited claims
  • Follow CMS’ guidance on separate line items and modifiers
  • Track your losses
  • Don’t bill beneficiaries
This tip was adapted from the article “Two years later, MUEs are still a puzzle” in the October issue of Briefings on APCs.



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