tci Part B Insider - 2006 Issue 12

PHYSICIAN NOTES: CMS Will Allow Second Round Of MUE Comments

'Medically unbelievable' edits shouldn't cramp your style You may be able to use a modifier to override the new “medically unbelievable” edits (MUEs), the Centers for Medicare & Medicaid Services says in a statement. The MUEs are just supposed to prevent “obviously erroneous” claims, and aren’t intended to be a new payment policy, CMS insists. CMS will work with providers to develop the statistical basis of these edits, and may let you override them for “clinical outliers.” CMS may also provide an appeals process if you receive an MUE-related denial. CMS announced that the...

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