Medically unlikely edits (MUEs), formally known as medically unbelievable edits, took effect with the Centers for Medicare & Medicaid Services (CMS) on January 2, 2007. The function of MUEs is to detect and deny unlikely CMS claims on a pre-payment basis with the intention of improving Medicare’s payment process.
Coding Corner Answer: January 2008
January’s Coding Answer
Clean Claims Equal Prompt Payment
Submitting a clean Medicare reimbursement claim the first time can save your practice thousands of dollars each year. The Centers for Medicare and Medicaid Services (CMS) defines a clean claim as “a submitted patient claim form without any defect or need for substantiation.”
Rheumatology Stakeholders Talk Quality
ACR urged to accelerate efforts to develop quality indicators
Fraud and Abuse: What’s the Difference?
Each year, fraud and abuse cost the Medicare and Medicaid programs billions of dollars. What is the difference between fraud and abuse? The Centers for Medicare & Medicaid Services define fraud and abuse as two different offenses…
Be Aware of New Waived Tests
Keeping current on changes to laboratory certifications for common lab tests can save your practice time—and money. Since the passage of the Clinical Laboratory Improvement Amendments (CLIA) in 1988, all health-assessment laboratory tests are ranked for complexity, and their complexity dictates which labs can process Centers for Medicare and Medicaid Services (CMS)–reimbursed tests. In accordance with CLIA, each laboratory facility must register with CMS to receive a CLIA certification. There are five certifications, each with differing degrees of complexity, listed from least to most complex: Certificate of Waiver, Certificate of Provider-Performed Microscopy Procedures, Certificate of Registration, Certificate of Compliance, and the Certificate of Accreditation.
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