MUE (Medically unlikely edits)
The Centers for Medicare & Medicaid Services (CMS) implemented Medically Unlikely Edits (MUEs) to reduce paid claim errors. An MUE is the maximum units of service a provider would report under most circumstances for a single beneficiary on a single date of service. Webpage contains links to MUE FAQs, MUE files and most aspects of the MUE program.
The Centers for Medicare & Medicaid Services (CMS) completed a review of medical unlikely edit (MUE) claims data and confirmed a pattern of inappropriate billing for bilateral surgical procedures using multiple lines to bypass the claim edits. This article was revised with more details and examples and was re-issued January 17. Providers who perform bilateral surgical procedures should review the entire article. [SE1422]
The Centers for Medicare & Medicaid Services (CMS) implemented date of service (DOS) medical unlikely edits (MUEs), maintained by the National Correct Coding Initiative (NCCI), for some codes effective April 1, 2013. Follow this link to view a frequently-asked question addressing this change.
Follow this link to view frequently-asked questions pertaining to medically unlikely edits.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.