tci Medicare Compliance & Reimbursement - 2022 Issue Q1

Reader Question: Know This Important Fact on MUEs

Question: We mostly see Medicare Part B beneficiaries at our practice and understand that this means that we need to understand how medically unlikely edits (MUEs) apply to our claims. We wondered, are there any situations in which we can override an MUE? AAPC Forum Participant Answer: In certain scenarios, if the physician performs a legitimate, medically necessary procedure that violates MUE edits, you may be able to still get paid from Medicare, despite the MUE. Reminder: “Medically Unlikely Edits (MUEs) are used by the Medicare Administrative Contractors (MACs), including Durable Medical Equipment (DME) MACs, to reduce the...

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