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CodeMap Compliance Briefing: 03/11/05


Editor's Welcome:

 

CMS has come up with the perfect name for its newest type of automatic claim edit, the Medically Unbelievable Edit (MUE). Since these new edits will be published on April 1st, there was some suspicion that an April Fool's joke might be involved. However, CMS is very serious about this addition to the CCI edit system as we will explain below. By the way, we can't wait for future refinements to the system including SUEs (somewhat unbelievable edits) and RUEs (really unbelievable edits). 

As always, feel free to reply to this email with questions or concerns.

Sincerely,

Charles Root, Ph.D.

Medically Unbelievable Edits

Background: In an effort to lower the Medicare claims error rate, CMS is establishing unit-of-service edits referred to as Medically Unbelievable Edits (MUEs). A MUE is defined as an edit that tests a claim for the same beneficiary, HCPCS code, date of service, and....

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