Corporate Compliance

Other Issuances: CMS releases updated lab NCD manual, posts FAQ on MUEs, ABNs

Medicare Insider, April 21, 2009

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CMS issues updated lab NCD manual

CMS has posted the April 2009 version of the NCD manual for clinical diagnostic laboratory services on its Web site.

View the lab NCD manual.

Frequently asked question: May an Advanced Beneficiary Notice (ABN) be utilized to bill the beneficiary for services denied due to an MUE?

A provider/supplier cannot bill the beneficiary for services denied due to an MUE. An MUE denial is an initial determination based on a coding denial, not a medical necessity denial. By statute an ABN may be applied only if the initial determination on a claim results in a denial due to medical necessity. If a provider appeals an MUE denial and some UOS are denied as not medically necessary, the provider should NOT apply an ABN to bill the beneficiary. An appeal is not an initial determination, and by statute the ABN provision only applies to the initial determination.

View the FAQ on the CMS Web site.



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