Four Tips to Overcome MUE Denials

So are your receiving denials from Medicare? One possibility could be you are running up against medically unlikely edits (MUEs).

Medical claims billing: The MUEs, which are designed to prevent overpayments, caused by gross billing mistakes, normally a result of result of clerical or billing systems' mistakes, many a time confuse veteran coders too.

Here are four aspects of these edits to see to it that you are not letting MUEs wreak havoc on your practice's coding and payments.

First, understand what MUEs are and how they work.

Some practices are of the opinion that they don't need to worry much about MUEs. The reality is any practice filing a claim with Medicare should know what MUEs are and how they function. One needs to be aware of MUEs as they occur. The MUE list covers specific CPT or HCPCS codes, followed by the number of units that CMS will pay. In fact, the agency had developed the MUEs to bring down paid claims error rates in the Medicare program. While some MUEs deal with anatomical impossibilities, others limit codes as per the CMS policy.

Second, you can't use ABNs to transfer responsibility for payment to the beneficiary.

The agency makes this rule very clear in its FAQs. What's more, if services are denied claim based on an MUE, an ABN can't be used to shift liability and bill the beneficiary for the denied services. It's a provider/supplier liability.

Third, you can certainly override an MUE contrary to popular belief that you can never override an MUE.

According to the agency, MUEs reflect the maximum number of units the vast majority of properly reported claims for a particular code would have; as such you don't need to override them. However, you can override an MUE when your doctor carries out and documents a medically necessary number of services that cross the limit.

Fourth, you can appeal if you receive a claim denial owing to MUEs

Yes, you can certainly appeal the claims and you can address inquiries regarding the rationale for an MUE. However, the warning is that you may not get the answer you want, and it'll take some time to receive your response.

For further details on this and for other medical claims billing and coding updates, sign up for a good coding resource like Supercoder. Such a site comes with SuperScrubber for Batch Processing to save you both the time and money lost re-working denied claims.