Corporate Compliance

Note: FAQs updated for changes in MUEs

Compliance Monitor, April 20, 2010

Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the author of this week’s note from the instructor.

CMS updated many of its Frequently Asked Questions (FAQs) regarding how Medically Unlikely Edits (MUEs) are processed. Implemented in 2007, MUEs were designed as units of service limits that detected “unlikely Medicare claims” to decrease the claims error rate for Part B outpatient services. There are two types of MUEs: anatomical errors (i.e. total removal of more than one thyroid gland on the same date of service) and typographical errors. Although CMS published most of the MUE edits on its website, some remain “proprietary” and are not known to the providers. 

Prior to April 1, 2010, if a line item for the same HCPCS code on the same date of service exceeded the MUE unit limit, the claim was returned to the provider or “RTP.” According to the Integrated Outpatient Code Editor (ICOE), when claims are RTP’d, the provider can resubmit the claim for payment consideration once the problem is corrected.

Continue reading Debbie Mackaman's note.

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