Beginning October 1, 2008, the Centers for Medicare and Medicaid Services (CMS) will publish most of the edits utilized in its Medically Unlikely Edit (MUE) program “to improve the accuracy of claims payments.” Historically, CMS did not publish the MUE values and considered this information highly confidential.
As some general background, CMS first implemented the MUE program January 1, 2007 to limit the maximum units of service that a provider can report under most circumstances for a single beneficiary on a single date of service. CMS sets the units of service for each MUE high enough to allow for what it determines are medically reasonable daily frequencies of clinical outpatient services provided in most outpatient or provider settings.
While CMS will not publish all MUEs on October 1, 2008, it will publish around 9,700 HCPCS/CPT codes that have been assigned unit values for MUEs. Additional MUEs will be published at the start of each calendar quarter, beginning on January 1, 2009. CMS indicated that the MUEs not published were primarily designed to detect and deter questionable payments rather than billing errors and that publishing them would diminish their effectiveness.
For more information about the MUE program, please contact PYA at (800) 270-9629.
