What are Medically Unlikely Edits?
Many provides have a good understanding of the National Correct Coding Initiative (NCCI) edits utilized by the Centers for Medicare and Medicaid Services (CMS) as well as other commercial insurance carriers, including some workers compensation carriers. However, most providers of outpatient therapy services are either unaware or lack a solid understanding of CMS’ medically unlikely edits (MUEs). In this article, I will answer the following questions: What are medically unlikely edits (MUEs)? What outpatient therapy practice settings does CMS apply MUEs to? Are there different MUEs for a private practice (submit claims on a 1500-claim form) and a facility-based provider