Medical Auditing Practice Exam

Which resource should be used when informing a provider that a specific code should not be reported with units?

1. Medically Unlikely Edits

2. Commercial payer guidelines

3. Practice management software

4. Billing and coding updates

The correct answer is: Medically Unlikely Edits

The most appropriate resource to utilize when informing a provider about not reporting a specific code with units is Medically Unlikely Edits (MUEs). MUEs are established by the Centers for Medicare & Medicaid Services (CMS) and are designed to identify codes that have a high likelihood of being reported in excess of what is normally deemed medically necessary or appropriate in a given situation. When a specific code is associated with MUEs, it indicates the maximum number of units that can be reported for that service on a single date of service. Thus, using MUEs helps ensure compliance with billing regulations and guidelines, ultimately avoiding potential denials or audits related to inappropriate billing practices. Other resources, such as commercial payer guidelines or practice management software, may assist in understanding overall coding guidelines and billing practices; however, they may not specifically denote restrictions on reporting units like MUEs do. Billing and coding updates can provide information on changes in regulations or coding practices, but they may not directly address the specific scenario of unit reporting. Therefore, MUEs are the most suitable resource for this particular situation.