tci Medicare Compliance & Reimbursement - 2022 Issue Q1

Reader Questions: Know These MUE Appeals Options

Question: We’ve been hit with a few Part B denials due to medically unlikely edit (MUE) problems. Are we allowed to appeal an MUE denial or are those set in stone? Missouri Subscriber Answer: Since the Centers for Medicare & Medicaid Services (CMS) developed the MUEs to reduce paid claims error rates in the Medicare Program, you may be inclined to think that you cannot appeal that denial — but you can. Reality: If you receive a claim denial due to MUEs, you can appeal the claims and you can address inquiries regarding the rationale for an MUE...

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