Health Information Management

Medicare publishes most MUEs

APCs Insider, October 3, 2008

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On October 1, CMS announced that it is immediately publishing most of the edits used in its Medically Unlikely Edit (MUE) program to improve the accuracy of claims payments.

“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. “This program is going to help us dramatically reduce costly payment errors.”

CMS began the MUE program to reduce payment errors for Medicare Part B claims, the announcement states. It says that Medicare contractors use MUEs “to assure that providers and suppliers do not report excessive services.”

According to the announcement, CMS began the MUE program January 1, 2007, with edits for about 2,600 HCPCS/CPT codes. The MUE program has made quarterly updates which added additional codes to this list. As of October 1, CMS says that the MUE program contains edits for about 9,700 CPT and HCPCS codes. Note, however, that CMS will not publish all MUEs on October 1.

To view the published edits, click here.



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