Question:

What is MUE, and why is it important?

Answer by Julia Markova, Account Representative at WCH:

MUE (Medically Unlikely Edits) is the maximum number of units of service allowed, under most circumstances, for the same provider on the same date of service for the same patient.

MUEs affect hospital outpatient departments, physicians and non-physician practitioners, and durable medical equipment (DME) suppliers. CMS believes the MUEs can catch clerical and coding errors, in addition to reducing fraud and abuse cases for certain claims.

Understanding why Medically Unlikely Edits (MUEs) were developed by CMS, how they are organized, and the criteria on which they are based is important for each medical practitioner in order to avoid denials from payers.

It's significant to keep in mind that MUEs are constantly changing. CMS publishes the updated list of MUEs quarterly but still reserves the right to create unpublished MUEs, which could be frustrating and hard to understand for medical providers.

WCH Service Bureau is always here to help! Our experienced coders, billers, and audit specialists are always standing as guardians of your reimbursement and compliance!

References: https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE