Myths about MUEs

Beware of MUEs as they occur, and you cannot use ABNs to transfer responsibility for payment to the beneficiary.

See to it that you are not letting medically unlikely edits (MUEs) play havoc on your urology practice's coding and reimbursement by unraveling the truth about four aspects of these edits.

The first myth is that MUE edits do not affect your practice

Some practices think that they do not need to worry about MUEs. However, we should be aware of MUEs as they occur.

The second myth is that you can bill the patient to overcome MUE limits

Some practices think that by having the patient sign an advance beneficiary notice (ABN), you can pass on the cost of procedures you know will be denied owing to MUEs. The reality is that you cannot use ABNs to transfer responsibility for payment to the beneficiary.

The third myth is that you can never override an MUE

Do not think that even if your doctor carries out a legitimate, medically necessary procedure that violates MUE edits, you cannot override the edits.

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

Ignorance as far as medically unlikely edits are concerned could be causing you medical coding(http://www.supercoder.com/) claim denials. To know more about medically unlikely edits and to stop denials, sign up for a one-stop medical coding website. Such a site will ensure that you stay updated on all coding know how.