Medically Unlikely Edits Outpatient Hospital Services

$179 / year

This dataset showcases the Medically Unlikely Edits (MUEs) as defined for many Healthcare Common Procedure Coding System (HCPCS) / Current Procedural Terminology (CPT) codes, the maximum allowable number of units of service by the same provider, for the same beneficiary, the same date of service, on the same claim line. Reported units of service greater than the MUE value are unlikely to be correct. The MUE outpatient hospital Services for the third quarter of 2017 are released on CMS website on June 02, 2017 and will be effective from July 1, 2017 to September 30, 2017.

Complexity

The Centers for Medicare and Medicaid Services (CMS) developed the Medically Unlikely Edit (MUE) program to reduce the paid claims error rate for Part B claims. The first edits were implemented in January 1, 2007. Subsequently there have been quarterly updates increasing the number of edits. The edits were developed based on anatomic considerations, HCPCS/CPT code descriptors, CPT instructions, CMS policies, nature of service/procedure, nature of the analyte, nature of the equipment, and clinical judgment. Prior to implementation, all edits were reviewed by national healthcare organizations, and their alternative recommendations were taken into consideration.
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 the 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 MUE Outpatient Hospital Services for the second quarter of 2017 are released on CMS website on June 02, 2017 and will be effective from July 1, 2017 to September 30, 2017.

Date Created

2015-12

Last Modified

2018-01-01

Version

2018-01-04

Update Frequency

Quarterly

Temporal Coverage

2017-07 to 2018-01

Spatial Coverage

United States

Source

John Snow Labs => Centers for Medicare and Medicaid Services

Source License URL

John Snow Labs Standard License

Source License Requirements

CPT codes, descriptions and other data only are copyright 1995 - 2016 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).

Source Citation

NA

Keywords

2017 MUE for 3rd Quarter, MUE DME Supplier Services, Durable Medical Equipment Supplier Services, Quarterly MUE Version updates, MUE, NCCI Edits, CCI Edits, MUE DME Supplier Services, Quarterly MUE Version Updates

Other Titles

2017 MUE DME Supplier services, DME Supplier Services MUE Values, Durable Medical Equipment Supplier Services MUE Values, MUE Adjudication Indicator, 2017 MUE DME Supplier Services, DME Supplier Services MUE Values, Durable Medical Equipment Supplier Services MUE Values, MUE Adjudication Indicator, 2017 MUE for 3rd Quarter, Durable Medical Equipment Supplier Services

NameDescriptionTypeConstraints
HCPCS_and_CPT_Code5 digit code that contains the Physicians Current Procedural Terminologystringrequired : 1
Outpatient_Hospital_Services_MUE_ValuesRepresents the maximum units of service that an outpatient can avail on a single date of service.integerlevel : Nominal
MUE_Adjudication_IndicatorDescribes the type of MUE.stringrequired : 1
MUE_RationaleDescribes the underlying basis for each MUE.stringrequired : 1
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<p>Amazon Simple Storage Service (Amazon S3) is an object storage service that offers industry-leading scalability data availability security and performance. This means customers of all sizes and industries can use it to store and protect any amount of data for a range of use cases such as websites mobile applications backup and restore archive enterprise applications IoT devices and big data analytics. Amazon S3 provides easy-to-use management features so you can organize your data and configure finely-tuned access controls to meet your specific business organizational and compliance requirements. Amazon S3 is designed for 99.999999999% (11 9's) of durability and stores data for millions of applications for companies all around the world.<br /> </p>
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<h3 id="Industry-leading_performance.2C_scalability.2C_availability.2C_and_durability" class="lb-txt-bold lb-txt-none lb-txt-18 lb-h3 lb-title" style="color:#232f3e;"> Industry-leading performance scalability availability and durability</h3>
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<p>Scale your storage resources up and down to meet fluctuating demands without upfront investments or resource procurement cycles. Amazon S3 is designed for 99.999999999% (11 9’s) of data durability because it automatically creates and stores copies of all S3 objects across multiple systems. This means your data is available when needed and protected against failures errors and threats.<br /> <a href="/s3/faqs/#Durability_.26_Data_Protection" target="_blank">Learn about S3 data durability &raquo;</a></p>
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<h3 id="Wide_range_of_cost-effective_storage_classes" class="lb-txt-bold lb-txt-none lb-txt-18 lb-h3 lb-title" style="color:#232f3e;"> Wide range of cost-effective storage classes</h3>
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<p>Save costs without sacrificing performance by storing data across the <b>S3 Storage Classes</b> which support different data access levels at corresponding rates. You can use <b>S3 Storage Class Analysis</b> to discover data that should move to a lower-cost storage class based on access patterns and configure an <b>S3 Lifecycle</b> policy to execute the transfer. You can also store data with changing or unknown access patterns in <b>S3 Intelligent-Tiering</b> which tiers objects based on changing access patterns and automatically delivers cost savings.<br /> <a href="/s3/storage-classes/">Learn more about the S3 Storage Classes &raquo;</a></p>
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<p>Store your data in Amazon S3 and secure it from unauthorized access with encryption features and access management tools. You can also use <b>Amazon Macie</b> to identify sensitive data stored in your S3 buckets and detect irregular access requests. Amazon S3 maintains compliance programs such as PCI-DSS HIPAA/HITECH FedRAMP EU Data Protection Directive and FISMA to help you meet regulatory requirements. AWS also supports numerous auditing capabilities to monitor access requests to your S3 resources.<br /> Learn more about <a href="/s3/features/#Access_management_and_security">S3 security</a> and <a href="/compliance/">compliance &raquo;</a></p>
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<p>Classify manage and report on your data using features such as: <b>S3 Storage Class Analysis </b>to analyze access patterns; <b>S3 Lifecycle</b> policies to transfer objects to lower-cost storage classes; <b>S3 Cross-Region Replication</b> to replicate data into other regions; <b>S3 Object Lock </b>to apply retention dates to objects and protect them from deletion; and <b>S3 Inventory</b> to get visbility into your stored objects their metadata and encryption status. You can also use <b><a href="#How_it_works_.E2.80.94_S3_Batch_Operations_.28in_preview.29">S3 Batch Operations</a></b> to change object properties and perform storage management tasks for billions of objects. Since Amazon S3 works with <b>AWS Lambda</b> you can log activities define alerts and automate workflows without managing additional infrastructure.<br /> <a href="/s3/features/#Storage_management_and_monitoring"> Learn more about S3 storage management features &raquo;</a></p>
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<p>Run big data analytics across your S3 objects (and other data sets in AWS) with our query-in-place services. Use <b>Amazon Athena</b> to query S3 data with standard SQL expressions and <b>Amazon Redshift Spectrum</b> to analyze data that is stored across your AWS data warehouses and S3 resources. You can also use <b>S3 Select </b>to retrieve subsets of object metadata instead of the entire object and improve query performance by up to 400%.<br /> <a href="/s3/features/#Query_in_place">Learn more about query in place &raquo;</a></p>
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<p>Store and protect your data in Amazon S3 by working with a partner from the <b>AWS Partner Network (APN)</b> — the largest community of technology and consulting cloud services providers. The APN recognizes migration partners that transfer data to Amazon S3 and storage partners that offer S3-integrated solutions for primary storage backup and restore archive and disaster recovery. You can also purchase an AWS-integrated solution directly from the <b>AWS Marketplace</b> which lists over 250 storage-specific offerings.<a href="/backup-recovery/partner-solutions/"><br /> Learn about the APN</a> and<a href="https://aws.amazon.com/marketplace"> AWS Marketplace &raquo;</a></p>
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<p><b><a name="preview"></a>S3 Batch Operations</b> lets you manage billions of objects at scale with just a few clicks in the Amazon S3 Management Console or a single API request. With S3 Batch Operations you can make changes to object metadata and properties or perform other storage management tasks such as copying objects between buckets replacing object tag sets modifying access controls and restoring archived objects from S3 Glacier&nbsp;— instead of taking months to develop custom applications to perform these tasks.</p>
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<p>Build scalable durable and secure backup and restore solutions with Amazon S3 and other AWS services such as <b>S3 Glacier</b> <b>Amazon EFS</b> and <b>Amazon EBS</b> to augment or replace existing on-premises capabilities. AWS and APN partners can help you meet Recovery Time Objectives (RTO) Recovery Point Objectives (RPO) and compliance requirements. With AWS you can back up data already in the AWS Cloud or use<b> AWS Storage Gateway</b> a hybrid storage service to send backups of on-premises data to AWS.<br /> <a href="/backup-restore/">Learn more about backup and restore &raquo;</a></p>
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<p>Protect critical data applications and IT systems that are running in the AWS Cloud or in your on-premises environment without incurring the expense of a second physical site. With Amazon S3 storage <b>S3 Cross-Region Replication</b> and other AWS compute networking and database services you can create DR architectures in order to quickly and easily recover from outages caused by natural disasters system failures and human errors.<a href="/disaster-recovery/"><br /> Learn more about DR &raquo;</a></p>
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<p>Retire physical infrastructure and archive data with <b>S3 Glacier</b> and <b>S3 Glacier Deep Archive</b> (<a href="/about-aws/whats-new/2018/11/s3-glacier-deep-archive/" target="_blank">coming soon</a>). These S3 Storage Classes retain objects long-term at the lowest rates. Simply create an S3 Lifecycle policy to archive objects throughout their lifecycles or upload objects directly to the archival storage classes. With <b>S3 Object Lock</b> you can apply retention dates to objects to protect them from deletions and meet compliance requirements. Unlike tape libraries S3 Glacier lets you restore archived objects in as little as one minute for expedited retrievals and 3-5 hours for standard retrievals. Bulk data restores from S3 Glacier and all restores from S3 Glacier Deep Archive are completed within 12 hours.<a href="/glacier/"><br /> Learn more about archiving &raquo;</a></p>
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<h3 id="Data_lakes_and_big_data_analytics" class="lb-txt-bold lb-txt-none lb-txt-18 lb-h3 lb-title" style="color:#232f3e;"> Data lakes and big data analytics</h3>
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<p>Accelerate innovation by creating a data lake in Amazon S3 and extract valuable insights using query-in-place analytics and machine learning tools. You can also use <b>AWS Lake Formation </b>to quickly create a data lake and centrally define and enforce security governance and auditing policies. The service collects data across your databases and S3 resources moves it into a new data lake in Amazon S3 and cleans and classifies it using machine learning algorithms. All AWS resources can be scaled up to accommodate your expanding data stores&nbsp;— without upfront investments.<br /> Learn more about <a href="/big-data/datalakes-and-analytics/">data lakes</a> and <a href="/lake-formation/">AWS Lake Formation &raquo;</a></p>
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<p>Create a seamless connection between on-premises applications and Amazon S3 with <b>AWS Storage Gateway</b> in order to reduce your data center footprint and leverage the scale reliability and durability of AWS as well as AWS’ innovative machine learning and analytics capabilities. You can also automate data transfers between on-premises storage and Amazon S3 by using <b>AWS DataSync</b> which can transfer data at speeds up to 10 times faster than open-source tools. Another way to enable a hybrid cloud storage environment is to work with a gateway provider from the APN. You can also transfer files directly into and out of Amazon S3 with<b> AWS Transfer for SFTP </b>— a fully managed service that enables secure file exchanges with third parties.<br /> Learn more about <a href="/storagegateway/">hybrid storage</a> <a href="/datasync/">AWS DataSync</a> and <a href="/sftp/">AWS Transfer for SFTP &raquo;</a>&nbsp;<br /> </p>
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<p>Build fast cost-effective mobile and Internet-based applications by using AWS services and Amazon S3 to store production data. With Amazon S3 you can upload any amount of data and access it anywhere in order to deploy applications faster and reach more end users. Storing data in Amazon S3 also means you have access to the latest AWS developer tools and services for machine learning and analytics to innovate and optimize your cloud-native applications.<br /> <a href="/products/developer-tools/">Learn more about cloud-native applications &raquo;</a></p>
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Netflix delivers billions of hours of content from Amazon S3 to customers around the world. Amazon S3 also serves as the data lake for their big data analytics solution.
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FINRA uses Amazon S3 to ingest and store data for over 75 billion market events daily and AWS Lambda functions to format and validate the data against more than 200 rules.
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Airbnb houses backup data and static files on Amazon S3 including over 10 petabytes of user pictures. As a born-in-the-cloud solution they continually innovate new ways to analyze data stored on Amazon S3.
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GE uses Amazon S3 to store and protect a petabyte of critical medical imaging data for its GE Health Cloud service which connects hundreds of thousands of imaging machines and other medical devices.
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<p><b>WHAT'S NEW</b><br /> <i>Coming Soon&nbsp;— S3 Glacier Deep Archive for Long-Term Data Retention</i><br /> 28 NOV 2018<br /> </p>
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<a href="/about-aws/whats-new/2018/11/s3-glacier-deep-archive/" target="_blank">Learn more &raquo;</a>
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<p><b>AWS NEWS BLOG<br /> </b><i>New&nbsp;— Automatic Cost Optimization for Amazon S3 via Intelligent Tiering</i><br /> by Jeff Barr | 26 NOV 2018<br /> </p>
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<a href="https://aws.amazon.com/blogs/aws/new-automatic-cost-optimization-for-amazon-s3-via-intelligent-tiering/" target="_blank">Learn more &raquo;</a>
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<p><b>WHAT'S NEW<br /> </b><i>Amazon S3 Introduces S3 Batch Operations for Object Management</i><br /> 26 NOV 2018<br /> </p>
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<a href="/about-aws/whats-new/2018/11/s3-batch-operations/" target="_blank">Learn more &raquo;</a>
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<p><b>WHAT'S NEW</b><br /> <i>AWS Announces Amazon S3 Object Lock in all AWS Regions</i><br /> 26 NOV 2018<br /> </p>
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<a href="/about-aws/whats-new/2018/11/s3-object-lock/" target="_blank">Learn more &raquo;</a>
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<p><b>AWS ARCHITECTURE BLOG</b><br /> <i>S3 &amp; S3 Glacier Launch Announcements for Archival Workloads</i><br /> by Matt Sidley | 26 NOV 2018<br /> </p>
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<a href="https://aws.amazon.com/blogs/architecture/amazon-s3-amazon-s3-glacier-launch-announcements-for-archival-workloads" target="_blank">Learn more &raquo;</a>
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<p><b>NEWS BLOG</b><br /> <i> Amazon S3 Block Public Access — Another Layer of Protection for Your Accounts and Buckets</i><br /> 16 NOV 2018<br /> </p>
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<a href="https://aws.amazon.com/blogs/aws/amazon-s3-block-public-access-another-layer-of-protection-for-your-accounts-and-buckets/" target="_blank">Learn more &raquo;</a>
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Check out the product features
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<p style="text-align: center;">Learn more about features for data management security access management analytics and more.<br /> </p>
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<a class="lb-tiny-align-center lb-txt-bold lb-txt-none lb-txt-blue-link lb-txt" href="/s3/features/"> Learn more&nbsp;<i class="icon-angle-double-right"></i></a>
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Sign up for a free account
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<p style="text-align: center;">Instantly get access to the AWS Free Tier and start experimenting with Amazon S3.&nbsp;</p>
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