Revenue Cycle

CMS to publish edits in its Medically Unlikely Edit (MUE) program

Recovery Auditor Report, October 4, 2008

Good news for those preparing for a RAC review: CMS is publishing most of the edits used in its Medically Unlikely Edit (MUE) program.

The regulators said in a press release yesterday the reason for publishing the edits – it began to do so yesterday – is “to improve the accuracy of claims payments.” MUEs are a major part of RACs.

Stacey Levitt, RN, MSN, CPC, the director of patient care management at Lenox Hill Hospital in New York City, NY, says the MUEs were a “significant focus” of her facility’s RAC reviews.

CMS established the MUE program January 1, 2007, to ensure providers and suppliers do not report excessive services on Medicare Part B claims. The material published yesterday will have edits for about 9,700 HCPCS/CPT codes.

The edits will be published on the CMS Web site here. To read the full press release from CMS, click here.

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