Health Information Management

Healthcare happenings: Medicare makes Medically Unlikely Edits available to the public

JustCoding News: Inpatient, October 8, 2008

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CMS announced that it will publish the majority of its Medically Unlikely Edits (MUE) as of October 1, according to a press release sent that same day. MUEs, which check the number of times a provider or supplier reports a service for the same patient on the same date of service, are updated on a quarterly basis.
 
Although the MUE program first took effect on January 1, 2007 and involved 2,600 HCPCS/CPT codes, approximately 9,700 HCPCS/CPT codes will be subject to the edits in the October 2008 version.
 
“It is always our aim to ensure that CMS pays for appropriate services, at the same time protecting the Medicare Trust funds and the American taxpayer,” said CMS Acting Administrator Kerry Weems in the press release.  “This program is going to help us dramatically reduce costly payment errors.”
 
The edits were developed by CMS with the cooperation and participation of national healthcare organizations representing physicians, hospitals, nonphysician practitioners, laboratories, and durable medical equipment suppliers. CMS also used claims data in its analysis of MUE.
 
To view the edits on the CMS Web site, click here.  To view the press release, click here.
 



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