tci Part B Insider - 2005 Issue 9

CODING EDITS: I Can't Believe It's Not Medically Necessary - Edits, That Is

Brand new edits could cut back the number of times you can bill each code You could soon find yourself playing Believe-It-Or-Not with Medicare over your usage of certain codes. The Centers for Medicare and Medicaid Services announced in Transmittal 105, issued Feb. 18, that it hired Adminastar Federal to develop new "medically unbelievable" edits (MUEs). These edits will target usages of particular codes that seem hard to believe according to Adminastar's number crunchers.Here's how it works: The National Correct Coding Institute ( NCCI) edits normally list a code in each of two columns. Instead, the new edits...

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