Sample of All FAQs (Helpie FAQ)

Helpie FAQ

  • MUE stands for Medically Unlikely Edits. It refers to the maximum number of units typically billed for a CPT or HCPCS code on a single date of service for one patient.
  • You can access the latest MUE files on the CMS National Correct Coding Initiative (NCCI) website, which includes CPT/HCPCS codes, unit limits, and adjudication indicators.
  • The best way to address recurring billing issues—including MUE denials, incorrect modifiers, and unit limits—is to work with experienced billing professionals. At Konnext Solutions, we specialize in identifying billing errors, correcting coding practices, and ensuring compliance with CMS and payer policies. Whether you're dealing with denials, appeals, or just need better accuracy—we’ve got you covered.

  • MAI (MUE Adjudication Indicators) define whether a denial can be appealed.

    • MAI 1: Clinically based (can be appealed)

    • MAI 2: Absolute limit (not appealable)

    • MAI 3: Policy-based (appealable with strong justification)

  • While MUEs are a CMS initiative, many private insurers use similar edits. Always check with individual payers and local MACs for their policies.

  • A professional billing service can:

    • Ensure accurate coding for behavioral health

    • Reduce denials by submitting clean, compliant claims

    • Manage appeals for denied claims

    • Communicate with insurers to negotiate better rates

    • Keep your practice compliant with HIPAA and state regulations

  • Out-of-network billing refers to services provided by mental health clinics or therapists who are not contracted with a patient’s insurance plan. This means higher out-of-pocket costs for patients and more complex billing processes for providers.

  • Many behavioral health professionals avoid in-network contracts due to low reimbursement rates, restrictive policies, and administrative burdens. Staying out-of-network gives them more control over treatment plans and practice operations.

    • Missing documentation

    • Use of non-covered codes or services

    • Incorrect diagnosis coding

    • Lack of pre-authorization

    • Timely filing issues

    • Accurately verify mental health benefits before treatment

    • Use correct diagnosis and procedure codes

    • Maintain thorough clinical documentation

    • Submit claims on time

    • Appeal denied claims with supporting documentation

  • Verification helps you identify if pre-authorization is needed, confirm coverage limits, and avoid surprise billing. It ensures both the clinic and patient understand financial responsibilities before services are rendered.
  • Yes. Patients are often responsible for the difference between provider charges and what the insurance reimburses. Providing a clear explanation of out-of-network billing and upfront estimates helps prevent confusion or disputes.

  • A professional billing service can:

    • Ensure accurate coding for behavioral health

    • Reduce denials by submitting clean, compliant claims

    • Manage appeals for denied claims

    • Communicate with insurers to negotiate better rates

    • Keep your practice compliant with HIPAA and state regulations

  • Common reasons include incorrect or outdated coding, lack of prior authorization, credentialing delays, and patient eligibility issues. Many of these are preventable with the right systems in place.

  • You can reduce denials by:

    • Keeping provider credentials updated

    • Training your team on the latest coding updates

    • Using automated claim scrubbing tools

    • Verifying patient eligibility before services

    • Staying current with payer rules and contract changes

  • Recurring denials often point to a process issue. You should audit your billing workflow, identify the root cause, and make adjustments. Partnering with a billing specialist like Konnext Solutions can help uncover and resolve these patterns.
  • Simply request a consultation. Our team will assess your current processes, identify key areas for improvement, and create a customized plan to help your practice reduce denials and improve cash flow.
  • Even when your documentation and billing seem correct, denials can still happen due to payer-specific rules, outdated credentialing, missing prior authorizations, or coding changes. Each payer has unique requirements, and minor discrepancies can trigger rejections.
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