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Medicare Publishes Medically Unlikely Edits
October 2008

CMS announced that effective October 1, 2008 most of the medically unlikely edits (MUEs) will be published. A MUE is the maximum number of units of service that a provider would report under most conditions for a patient on a particular date of service.

Initially the edits were developed to reduce the claims error rate for Part B claims. Until now these edits were not published for providers.

CMS utilizes these edits to assure that providers do not report excessive services. The edits are applied during the processing of a claim.

The edits are listed on the CMS website at:
http://www.cms.hhs.gov/NationalCorrectCodInitEd/08_MUE.asp#TopOfPage

   

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