Which of the following best defines what “medically unlikely edit” (MUE) aims to target?

The term "medically unlikely edit" (MUE) specifically targets scenarios where the services provided are not medically necessary or where there is a clear over-utilization based on clinical guidelines. MUEs are used as a tool for Medicare and other payers to identify outlier claims that may indicate improper billing due to incorrect coding practices. The primary focus of MUEs is to ensure that coding aligns with established clinical standards and guidelines, thus ensuring that services billed are clinically reasonable and necessary for a patient's care.

This approach helps prevent billing for an excessive quantity of services that would not typically be performed within a certain timeframe or clinical context, enhancing the integrity of the revenue cycle. By addressing incorrect coding, MUEs promote accurate claims submissions and reduce denials based on over-utilization of services that do not meet the criteria established by medical necessity.