Revenue Cycle

RAC audits now a potential risk for physicians

Recovery Auditor Report, March 18, 2010

Earlier this year, two of the four RACs added Medically Unlikely Edits (MUE) to their list of CMS-approved issues. The approval of these issues now gives RACs a new set of issues to study, which includes physician services.
MUEs are units of service edits for HCPCS codes when a single provider / supplier render the services to a single beneficiary on the same date of service, according to CMS.

While physician services have not been the target of RACs since early in the demonstration project, the approval of MUEs by Connolly and HDI puts them back on the RAC radar. (Editor’s note: CGI had approved the issue as well, but has since removed it.)

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