Question

Review the Outpatient Medical Unlikely Edits, select one from the "Facility Outpatient Services MUE Table- Effective April/17" and analyze it, explain it thoroughly (4 points) Warning, this site is updated several times per year so the date might be different.

Answer 1

HOW WERE MUES DEVELOPED? MUE )Medically Unlikely Edits) was implemented in January 1, 2007 and were developed based on code descriptors, CPT coding instructions, anatomic considerations, established CMS policies, nature of service/procedure, nature of analyte, nature of equipment and clinical judgement. All these were reviewed by workgroups of contractor medical directors. Some contractors allow providers to report repetitive services performed over a range of dates on a single line of claim with multiple units of service.In brief a)The Centers for Medicare and Medicaid services developed Medically Unlikely Edits (MUE) to reduce the paid claims error rate. b) An MUE for a HCPCS/CPT ( current procedural terminology) code is the maximum units of service that a provider would report under most circumstances for a single beneficiary for a single date of service. Moreover all these codes donot have an MUE. c) Accurate coding and reporting of services are critical aspects of proper billing. d) They help providers to avoid coding and billing errors and subsequent payment denials.