tci Medicare Compliance & Reimbursement - 2007 Issue 37

COMPLIANCE: Prepare For A Whole New Set Of Denials In January

MUEs sail past anatomy into the realm of clinical decision makingWarning: The controversial medically unlikely edits (MUEs) are taking a big step into the unknown starting in January ...quot; and your claims could wind up on the chopping block as a result. Big change: Until now, the MUEs have focused on anatomically unlikely scenarios. For example, if you try to bill for a hysterectomy on a male patient, or amputation of three arms, these edits will kick in and prevent it. But starting in January, Phase V of the MUEs will focus on "clinical judgment" instead.The MUEs will...

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