tci Part B Insider - 2007 Issue 31

MEDICALLY UNLIKELY EDITS: Prepare For A Whole New Wave Of Denials In January

The medically unlikely edits are sailing past anatomy into the realm of clinical decision makingWarning: The controversial medically unlikely edits (MUEs) are taking a big step into the unknown starting in January--and your claims could wind up on the chopping block as a result. Big change: Until now, the MUEs have focused on anatomically unlikely scenarios. For example, if you try to bill for a hysterectomy on a male patient, or amputation of three arms, these edits will kick in and prevent it. But starting in January, Phase V of the MUEs will focus on -clinical judgment- instead.As...

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