What does 2 date of service edit policy mean?
MUE edits with an MUE Adjudication Indicator (MAI) of “2” (Date of Service Edit: Policy): a. The MUE value is an absolute date of service limit that may not be overridden or bypassed with a modifier. b. MUE edit limits with an MAI of “2” have been rigorously reviewed and vetted within CMS.
What is a procedure to procedure edit?
NCCI Procedure-to-Procedure (PTP) edits are code pair edits that prevent improper payment when certain codes are submitted together.
What is MUE policy?
A Medically Unlikely Edit (MUE) is a US Medicare unit of service claim edit applied to Medical claims against a procedure code for medical services rendered by one provider/supplier to one patient on one day. MUE are designed to limit fraud and/or coding errors.
What is the purpose of NCCI edits?
The purpose of the NCCI PTP edits is to prevent improper payment when incorrect code combinations are reported. The NCCI contains one table of edits for physicians/practitioners and one table of edits for outpatient hospital services.
What are edits in healthcare?
What are claim edits? According to Healthcare Innovation, healthcare claims editing is a step in the claims payment cycle that involves verifying that physician-submitted bills are coded correctly.
How often are NCCI edits updated?
quarterly
Remember that NCCI tables are updated quarterly and saved tables must be replaced in order to have the most current information. We will demonstrate how to use the PTP code pair tables, using code 99215 and two of the four Practitioner PTP Edits tables as our examples.
What is a CMS NCCI Column 1 Column 2 edit?
Column 1 indicates the payable code. Column 2 contains the code that is not payable with this particular Column 1 code, unless a modifier is permitted and submitted. The third column indicates if the edit was in existence prior to 1996. The fourth column indicates the effective date of the edit (year, month, date).
What happens if the Mue is adjudicated as a date of service?
If the MUE is adjudicated as a date of service edit, all units on each claim line for the same date of service and HCPCS Level II/CPT® code are summed, and the sum is compared to the MUE value. If the summed units on the claim exceed the MUE value, all units for the HCPCS Level II/CPT® code for that date of service are denied.
How many units of service can be included in a Mue?
The edit is based on the nature of the service. Specifically, CPT® code 96003 is for one muscle, so the units of service should not exceed one. Some MUEs are date of service edits based on clinical information.
How do I contact the Mue program?
The public/confidential status of MUEs may change over time. Inquiries about the MUE program, including those related to NCCI (PTP, MUE and Add-On) edits, should be sent to [email protected]. Inquiries about a specific claim should be addressed to the appropriate MAC.
What are Medically Unlikely Edits (Mue)?
The Centers for Medicare & Medicaid Services (CMS) developed Medically Unlikely Edits (MUE) to reduce the paid claims error rate.