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Pediatric Coding Alert

CCI Edits:

Know How 'Medically Unlikely' CCI Edits Can Derail Your Reimbursement

Published on Sat Nov 20, 2010

Ignore the MUEs and expect a claim rejection. If you receive CCI-based denials from Medicaid but can't find the edits in the CCI spreadsheet, one possibility is that you're running up against medically unlikely edits (MUEs). The edits, which are designed to prevent overpayments caused by gross billing errors, are usually a result of clerical or billing systems' mistakes. Get to know what MUEs are and how they'll affect your Medicaid pay as your pediatric practice enters the new year. Myth 1: MUE Edits Don't Affect Your Practice Some practices feel that they don't need to worry about MUEs. Reality: While you shouldn't stress too much, any practice filing a claim with Medicaid should know what MUEs are and how they work. The MUE list includes specific CPT or HCPCS codes, followed by the number of units that CMS will pay, says Jillian Harrington, MHA, CPC, CPC-P, CPC-I, CCS-P, president [...]
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