AMA CPT® Assistant - 2006 Issue 12 (December)
Medically Unlikely Edits (MUEs) (December 2006)
December 2006 page 15 Medically Unlikely Edits (MUEs) Question I have been hearing about a new set of CMS edits called MUEs? What are they and when will they be implemented? AMA Comment The Centers for Medicare and Medicaid Services (CMS) will be implementing a new program of edits on January 1, 2007. The Medically Unlikely Edits (MUEs), previously known as the Medically Unbelievable Edits, are units of service edits that reflect the maximum number of units of service that a provider might report for the same HCPCS/CPT code for the same beneficiary on the same date of service...
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Article Overview
This short CPT Assistant article gives a high-level overview of CMS Medically Unlikely Edits, including the program’s purpose, its planned implementation timing, and the broad types of criteria CMS said would be used in later phases. It is relevant for coding, billing, and compliance professionals who need to track Medicare edit changes affecting HCPCS/CPT claims processing.
Why This Topic Matters
It helps readers understand an upcoming CMS claims-edit initiative and why it may affect unit reporting and pre-payment review for Medicare claims.
What You Will Learn
- What CMS Medically Unlikely Edits are at a high level
- When CMS planned to begin implementing the MUE program
- The general basis for the initial phase and later phases of the edit program
- Where to look for additional information referenced by the article
Who Should Read This
- Medical coders
- Billing professionals
- Compliance staff
- Revenue cycle teams
- Physician practice administrators
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