tci Part B Insider - 2013 Issue 16

Appeals: CMS Just Updated Medically Unlikely Edits--Do You Know How to Appeal Them?

Many MUEs make sense, but for those that don’t, you can fight back. By now, most practices are familiar with Medicare’s medically unlikely edits (MUEs), which CMS instituted to prevent overpayments caused by gross billing errors. On April 1, CMS updated the MUE listing, and some of your favorite codes may now be limited by the bundles. When you scour your unpaid claims, make sure you are watching for MUE denials to ensure that you’re getting paid when appropriate but that you fight back when your claims are inappropriately denied. Get to Know What MUE Edits...

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