decisionhealth Newsletters, Coder Pink Sheets - 2020 Issue 10 (October)
Medically unlikely edits for common E/M and virtual encounters
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Article Overview
This article is a short administrative update for coding and billing staff. It discusses the return of pre-public health emergency medically unlikely edits, the timing of the change, and why practices should review internal processes to reduce avoidable claim denials. The content is relevant to teams handling evaluation and management and virtual encounter services.
Why This Topic Matters
It helps billing and coding staff prepare for an upcoming edit policy change that may affect claim submission and denial patterns for common office and telehealth-related encounters.
What You Will Learn
- The timing of the medically unlikely edits change
- Why staff should review billing workflows ahead of the effective date
- How the update relates to common evaluation and management and virtual encounter claims
- Why the change may affect denial prevention efforts
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle teams
- Practice managers
- Compliance staff
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