Corporate Compliance

Note from Hugh

Medicare Insider, March 25, 2008

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This week, I'd like to follow-up on another issue from the March 13, CMS Hospital Open Door Forum conference call relating to the Medical Unlikely Edits (MUEs). On that call, a caller reported that she has been in contact with Correct Coding Solutions LLC (the contractor that handles the MUEs) regarding the application of the MUEs to certain infusion/injection claims. The caller reported that she had been informed that effective April 1, Correct Coding Solutions LLC is implementing a "fix" relating to certain infusion/injection MUEs and that providers should resubmit claims after that date. Although not at all clear, the implication was that the MUEs in question may be inaccurate or inappropriate.

Where does this leave hospitals? It appears that hospitals may want to examine their recent infusion/injection claims to see if the claims are being "Returned to Provider" based on Outpatient Code Editor edit 15 ("service unit out of range for procedure"). If so, hospitals may want to submit adjustment claims after April 1 (assuming that the units of service are in fact accurate and clinically appropriate) and/or contact their local FI or MAC for further guidance on this issue.



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