Practice Management & Allied Staff News & Materials
Medically Unlikely Edits Not Available to Public
July 17th, 2007
Unlike the Correct Coding Initiative (CCI) edits, Medicare will not make its newest effort to lower the Medicare fee-for-service paid claims error rate, Medically Unlikely Edits (MUEs), available to the public.
According to CMS, a public list of MUEs "may be misused by some providers to inappropriately bill the maximum number of units based on the MUE." As such, it will be important to carefully review Explanation of Benefits (EOBs) as they are received to track units of service that trigger edits for particular codes. One of the easiest ways to tell whether a particular line of a claim form has been hit by an MUE is via the remark code. Remark code N362 represents a number of days or units of service exceeding an acceptable maximum. While this remark code is not used exclusively for MUEs, it does provide a pretty good indication of what may be happening. Remember, excess charges due to units of service greater than the MUE may not be billed to the beneficiary, but will be considered a provider liability. For more information, see the recently revised MLN Matters article MM5603, the March/April AAOMS Today newsletter, the Practice Management section of the AAOMS Web site and the January 2007 Advocacy e-Newsletter.