Medically unlikely edits remain a puzzle to providers
APCs Weekly Monitor, May 30, 2008
Want to receive articles like this one in your inbox? Subscribe to APCs Weekly Monitor!
Earlier this year, CMS advised that the medically unlikely edit (MUE) value for units with CPT infusion codes 90766 or 90761, billed to FIs, would be increased on April 1, retroactive to the original date of January 1. However, not until the end of April did providers begin to notice infusion and injection claims being accepted for values that had previously been rejected, whereas reports of other MUEs appeared in the April CMS Hospital Open Door Forum.
Until the changes, CPT codes 90766 and 90761 with units of service greater than an unknown but variable quantity resulted in MUE denials, even when the services were clinically appropriate. The variable number of units causing denials increased provider frustration.
Click here to learn more about MUEs. Briefings on APCs subscribers have free access to this article in the April issue via their online subscriptions.
Want to receive articles like this one in your inbox? Subscribe to APCs Weekly Monitor!
Comments
0 comments on “Medically unlikely edits remain a puzzle to providers ”
Related Products
-
Briefings on The Joint Commission
Briefings on The Joint Commission will help you with all of your accreditation and survey preparation needs. Every month...
-
The CMS Survey Coordinator's Handbook
There is no reason to struggle with CMS requirements. HCPro has teamed up with former contracted CMS surveyor Jeff Coleman...
-
The Medicare Part B Billing Manual for Long-Term Care
This 150-page book breaks down Part B billing into separate revenue streams and includes examples of how to fill out the...
-
The RUG-IV Conversion: Financial Implications for Your Facility
When RUG-IV takes effect on October 1-whether in part or in full-is your facility prepared for the financial and operational...
-
The Complete Guide to Long-Term Care Medicare Billing
The Complete Guide to Long-Term Care Medicare Billing provides easy-to-understand guidance to help long-term care facilities...
Most Popular
- Articles
-
- Q/A: Volume requirement for reporting hydration services
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- Catch up on what's new with injections and infusions
- Identify potential Medicaid RAC target areas
- Topic: CMS, OESS post new security compliance review information, checklist
- HIPAA Q&A: Level of encryption needed for email
- Capturing all necessary codes for IUD insertion and removal can be challenging
- What does case-mix index mean to you?
- OB services: Coding inside and outside of the package
- QA:Coding multiple initial infusions
- E-mailed
-
- Q/A: Volume requirement for reporting hydration services
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- HIPAA Q&A: Level of encryption needed for email
- Q&A: Follow CMS' coding guidelines when using modifier -25
- What does case-mix index mean to you?
- Catch up on what's new with injections and infusions
- CMS has reformulated payments for some bilateral procedures
- New conflicts of interest create new challenges
- Q/A. One injection code or two?
- ED-to-inpatient transfers are flawed with safety gaps
- Searched