DME Supplier Hospital and Practitioner Services Report Codes

This data package contains the Medically Unlikely Edits (MUEs) which are 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. 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. The MUEs Outpatient Hospital Services which 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 MUEs Practitioner Services are also a part of this data package. The edits were developed based on anatomic considerations, HCPCS/CPT code descriptors, CPT instructions, Centers for Medicare and Medicaid Services (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.

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1. Medically Unlikely Edits Durable Medical Equipment Supplier Services

This dataset showcases the Medically Unlikely Edits (MUEs) for Durable Medical Equipment Supplier Services 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.

2. Medically Unlikely Edits Outpatient Hospital Services

This dataset showcases the Medically Unlikely Edits (MUEs) for outpatient hospital services 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.

3. Medically Unlikely Edits Practitioner Services

This dataset showcases the Medically Unlikely Edits (MUEs) for Practitioner Services 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.

4. Physician Supplier Procedure Summary 2019

The Physician/Supplier Procedure Summary (PSPS) dataset is a summary of the calendar year Medicare Part B carrier and durable medical equipment fee-for-service claims. The dataset is organized by carrier, pricing locality, Healthcare Common Procedure Coding System (HCPCS) code, HCPCS modifier, provider specialty, type of service, and place of service.

We deliver high-quality data

• Each dataset goes through 3 levels of quality review
  • 2 Manual reviews are done by domain experts
  • Then, an automated set of 60+ validations enforces every datum matches metadata & defined constraints
• Data is normalized into one unified type system
  • All dates, unites, codes, currencies look the same
  • All null values are normalized to the same value
  • All dataset and field names are SQL and Hive compliant
• Data and Metadata
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  • Metadata is provided in the open Frictionless Data standard, and its every field is normalized & validated
• Data Updates
  • Data updates support replace-on-update: outdated foreign keys are deprecated, not deleted

Our data is curated and enriched by domain experts

Each dataset is manually curated by our team of doctors, pharmacists, public health & medical billing experts:

• Field names, descriptions, and normalized values are chosen by people who actually understand their meaning
• Healthcare & life science experts add categories, search keywords, descriptions and more to each dataset
• Both manual and automated data enrichment supported for clinical codes, providers, drugs, and geo-locations
• The data is always kept up to date – even when the source requires manual effort to get updates
• Support for data subscribers is provided directly by the domain experts who curated the data sets
• Every data source’s license is manually verified to allow for royalty-free commercial use and redistribution.

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John Snow Labs , an AI and NLP for healthcare company, provides state-of-the-art software, models, and data to help healthcare and life science organizations build, deploy, and operate AI projects.