Avoid payer denials by ensuring your provider or supplier follows the rules for allowable MUE units. Understanding why Medically Unlikely Edits (MUEs) were established, how they are organized, and the criteria on which edit rationales are based may help medical coders and billers avoid denials or, at a minimum, properly resolve a denial. What Are ...
In Audit
Mar 7th, 2018
Section-specific examples have been added to the Medicare National Correct Coding Initiative (NCCI) Policy Manual. These examples reveal the rationales behind the edits contractors use to vet medical claims for incorrect code combinations. Take the Initiative to Correct Coding The Centers for Medicare & Medicaid Services (CMS) implemented the NCCI to promote national correct coding methodolog...
Follow the correct edit to promote payment and avoid denial. By Samantha Prince, BSHCM, COC, CPC, CPMA National Correct Coding Initiative (NCCI) edits for Medicare and Medicaid are not the same. If you’re following Medicare edits for Medicaid claims, you may have claims denying inappropriately. That’s missed revenue you could capture by applying the correct ...
Correct coding relies on understanding the edit tables and what the columns mean. By Ellen Hinkle, CPC, CPC-I, CPMA, CRC, CEMC, CFPC, CIMC It’s important to understand how the National Correct Coding Initiative (NCCI) affects medical coding and provider reimbursement. The Centers for Medicare & Medicaid Services (CMS) implemented this initiative in 1996 to promote ...
Feb 1st, 2016
Medically unlikely edits add restrictions to these codes. The American Medical Association (AMA) focused on prolonged services for 2016 CPT®. New codes were created and guidelines have been updated. Take note, and apply the changes when reporting these evaluation and management (E/M) services. Report Initial Prolonged Service Once, per Day Although medically unlikely edits (MUEs) ...