Medically Unlikely Edits Now Available

more+
less-

At last, providers and suppliers can review most of the edits that Medicare has put into place to ensure that Medicare is not being billed for excessive services

under Part B through incorrect coding or clerical errors. Beginning October 1, 2008, CMS is publishing a list of Medically Unlikely Edit (MUE) values for about 9,700 HCPCS/CPT codes, to check number of times a service is reported for the same patient on the same date of service for each code so as to improve the accuracy of claims submission. These edits are based on anatomical considerations (e.g., procedures performed on eleven fingers), code descriptors, CPT instructions, CMS policies, the nature of the procedure or service, and the nature of the equipment or analyte involved, and clinical

judgment. The edits will be published on the CMS website at

www.cms.hhs.gov/NationalCorrectCodInitEd/08_MUE.asp.

CMS is withholding from publication those MUE values that it uses to detect and deter questionable payments rather than billing errors. CMS also cautions that the published MUE values should not be construed to be permissible

utilization guidelines, and that only services that are medically necessary and reasonable should be billed.

LOADING PDF: If there are any problems, click here to download the file.


DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

© Ober|Kaler | Attorney Advertising

Written by:

more+
less-

Ober|Kaler on:

JD Supra Readers' Choice 2016 Awards
Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:

Sign up to create your digest using LinkedIn*

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.

Already signed up? Log in here

*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.
×
Loading...
×
×