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Coding

memorize.aimemorize.ai (lvl 286)
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Section 1

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medically unlikely edits (MUEs)

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Last updated

1 year ago

Date created

Mar 14, 2020

Cards (8)

Section 1

(8 cards)

medically unlikely edits (MUEs)

Front

units of service edits used to lower the Medicare fee-for-service paid claims error rate- maximum units of service that a provider would report under most circumstances

Back

Indicator 9 NCCI

Front

An NCCI edit does not apply- not applicable

Back

NCCI - national correct coding initiative

Front

This program was developed by CMS to promote national correct coding methods and to control inappropriate payment of Part B claims and hospital outpatient claims *used to determine codes considered by CMS to be bundled codes, which are not reported separately

Back

Indicator 0 NCCI

Front

Not allowed- no modifiers

Back

Medicare Modernization Act

Front

Required a 3 year recovery audit and hired Recovery Audit Contractors to identify overpayments and underpayments made

Back

Indicator 1 NCCI

Front

Allowed- modifiers can be used to bypass edits

Back

Recovery Audit Contractor (RAC)

Front

a 3rd-party entity working under the direction of CMS to detect improper Medicare payments through review of providers' medical records an Medicare claims data *5 working per region

Back

RAC audit process

Front

*Review claims going back 3 years *Perform automated or complex reviews

Back