"Medically Unbelievable Edits" to be Implemented by CMS on July 5, 2005

Barnes, Krista
October 2004
Venulex Legal Summaries;2004 Q4, p1
The article focuses on Medically Unbelievable Edits, a system that will automatically deny Medicare claims for services which exceed a specified number of service units per day, created by the U.S. Centers for Medicare and Medicaid Services. The system will examine such claims for the same beneficiary, healthcare common procedure coding system code, dates of service and billing provider. A table that lists the maximum allowable number of units for each code will be distributed by the Correct Coding Initiative contractor.


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