All Entries Tagged With: "MUE"
FIND quarterly updates
Flipping over the calendar from September to October means there are plenty of updates available to MedicareFind subscribers.
The latest versions of the NCCI edits, both on the physician and hospital outpatient side, have been loaded into our NCCI edit lookup tool. Keep in mind that the hospital outpatient edits are one quarter behind the physician edits.
The quarterly updates to the medically unlikely edits (MUE) is available. As before, some of the MUEs remain unpublished.
And you can now locate the following, in addition to other quarterly changes:
- Third quarter updates to OPPS Addendum A and Addendum B
- The October 2009 lab NCD manual
- The latest I/OCE update
Sign up for a free trial to MedicareFind to access updates like these and more.
Medically Unlikely Edits and medical necessity
Kimberly Hoy previously focused on recently issued FAQ 9697. In FAQ 9697, CMS restated its position that hospitals cannot bill beneficiaries for units of service in excess of MUE limits, even when the hospital has provided an ABN to the beneficiary prior to the provision of the services subject to the MUE. CMS’s rationale is that MUEs are coding edits, not medical necessity edits. [more]
Medically Unlikely Edits and ABNs
This was an especially light week for items from CMS for hospitals. This is, perhaps, because shortly we should see the FY2010 Inpatient Prospective Payment System Proposed Rule.
I did want to discuss a new FAQ on Medically Unlikely Edits (MUEs) that brings up some questions. The new FAQ focuses on Advanced Beneficiary Notices (ABNs), pointing out that a beneficiary can not be billed for units in excess of an MUE even if the provider issues an ABN to the beneficiary. CMS explains that an MUE denial is a coding denial, and that ABN provisions only apply to medical necessity denials. [more]
