decisionhealth Newsletters, Coder Pink Sheets - 2007 Issue 7 (July)
July MUEs hit radiology, lab, DME codes hardest
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Article Overview
This article reviews a July update to Medicare’s medically unlikely edits and discusses how the change affects broad claim-edit policy for radiology, laboratory, durable medical equipment, and some evaluation and management services. It is aimed at coding and reimbursement professionals who monitor claim-edit updates, specialty-society review activity, and the general factors used in edit determinations. The piece also notes that some existing edits were being revised and highlights the types of modifiers and service characteristics referenced in the update.
Why This Topic Matters
MUE updates can change claim processing outcomes and denial risk across multiple departments, so organizations need to track when new edits take effect and which service categories are impacted.
What You Will Learn
- What a July update to Medicare medically unlikely edits covers at a high level
- Which broad service categories were heavily affected by the update
- What general factors are referenced in determining edit changes
- How edit revisions can affect claim-line processing and denial risk
Who Should Read This
- Medical coders
- Coding managers
- Compliance staff
- Revenue cycle professionals
- Billing staff
- Practice administrators
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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