Health Information Management

Tip: Responding to MUE denials

APCs Insider, May 21, 2010

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In one-time notification R617OTN, CMS notes that organizations can report reasonable and necessary units of service exceeding the medically unlikely edit (MUE) on separate lines with appropriate modifiers. MUE edits are set to trigger only if a line item, not the entire claim, has excess units. Providers can report reasonable and necessary units on separate lines and avoid triggering the edits, according to CMS.

If hospitals have internal edits that add these lines and report them on one line, they should consult their software vendors about disabling this editing function with respect to MUEs.

Hospitals also should watch closely to ensure that contractors have updated their systems and are applying the guidance pertainign to MUEs correctly.

This tip is adapted from “Now on the to-track list: medically unlike edit appeals” in the May issue of Briefings on APCs.



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