Best Practice for Speeding Up Claims Payment

You can improve the turnaround time it takes to get claims paid by avoiding this common billing taboo: Don’t report the same procedure code on multiple lines to account for units of service.

There’s a more efficient billing method that will help your correctly coded claims sail through adjudication. The keys to success are Medically Unlikely Units (MUE) and modifiers.

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MUEs indicate what the Centers for Medicare & Medicaid Services (CMS) considers the maximum units of service that a provider would report under most circumstances for a single beneficary on a single date of service. And modifiers identify extenuating circumstances.

When you take MUEs and modifiers into account, you can report a procedure code on one line with multiple units (up to the MUE limit), and report subsequent units on additional lines using the appropriate modifier.

For example, if you were billing for a pathology exam on three breast biopsy specimens, you would report on one line CPT® code 88305 and 3 units, rather than three lines of 88305 with 1 unit each.

Taking this one step further, let’s say you have five units of 88305 to report and the MUE is three. Correct billing would be to report one line of 88305 with 3 units and one line of 88305-91 with 2 units. Modifier 91 Repeat clinical diagnostic laboratory test overrides the MUE, and reporting the multiple units on just two lines (instead of five) prevents a denial based on duplicate reporting.

The Centers for Medicare & Medicaid Services (CMS) posts the MUEs on their website.

Source: UnitedHealthcare Medicare Solutions

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Renee Dustman

Renee Dustman

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.
Renee Dustman

About Has 423 Posts

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.

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