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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. Claim edits compare different values on medical claim to a set of defined criteria to check for irregularities, often in an automated claims processing system. MUE are designed to limit fraud and/or coding errors. They represent an upper limit that unquestionably requires further documentation to support. The ideal MUE is the maximum unit of service for a code on the majority of medical claims. MUE is part of the National Correct Coding Initiative (NCCI) to address coding methodologies. The NCCI policies are based on coding conventions by nationally recognized organizations and are updated annually or quarterly.
The Healthcare Common Procedure Coding System is a set of health care procedure codes based on the American Medical Association's Current Procedural Terminology (CPT).
Berenson-Eggers Type of Service (BETOS) categories are used to analyze Medicare costs. All Health Care Financing Administration Common Procedure Coding System (HCPCS) procedure codes are assigned to a BETOS category. BETOS codes are clinical categories. There are seven high-level BETOS categories:
Clinical documentation improvement (CDI), also known as "clinical documentation integrity", is the best practices, processes, technology, people, and joint effort between providers and billers that advocates the completeness, precision, and validity of provider documentation inherent to transaction code sets sanctioned by the Health Insurance Portability and Accountability Act in the United States.
References
- ↑ "Health Care Common Procedure Coding System (HCPCS) Level II Codes". American Speech-Language-Hearing Association (ASHA). Retrieved 1 April 2012.
- ↑ "What is HCPCS?". AAPC. Retrieved 1 April 2012.
- ↑ "Procedure Code Overview". State of Wisconsin, Department of Health Services, Clinical Advisory Committee on Health and Emerging Technology. March 25, 2010. Retrieved 2010-12-12.
- ↑ "HCPCS Level II". AAPC. Retrieved 8 April 2019.