Responding to the American Physical Therapy Association and other health care organizations, the Centers for Medicare & Medicaid Services (CMS) reports that it will publish on its Web site most of the coding edits used in its "Medically Unlikely Edit" (MUE) program.
The agency initiated the MUE program to improve the accuracy of Part B claims payments. An MUE is the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service.
Through the MUE program, claims-processing contractors are instructed to check the number of times a service is reported by a provider or supplier for the same patient on the same date of service, and deny claims that exceed the maximum units.
However, PTs and other providers have been unable until now to know which services—and the maximum number of units reported for each one—would trigger MUE denials.
At the start of each calendar quarter, CMS will publish most MUEs active for that quarter. Although the October 1 release contains most MUEs, additional edits will be published on January 1, 2009. CMS reports that some MUEs deemed to be vulnerable to fraud and abuse will remain confidential.
[Source: American Physical Therapy Association]
