CMS Billing Edits to Reduce Payment Errors Posted Online

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Written by Stephanie Wasek

Wednesday, 01 October 2008

CMS has published online most of the edits utilized in its Medically Unlikely Edit (MUE) program to improve the accuracy of claims payments for Medicare Part B services.

These edits, applied during the electronic processing of all claims, check the number of times a service is reported by a provider or supplier for the same patient on the same date of service. This helps prevent overpayment errors that may be caused by a number of factors, including clerical errors and coding errors.

CMS first implemented the MUE program Jan. 1, 2007, with edits for about 2,600 HCPCS/CPT codes. There have been quarterly updates adding additional codes. The Oct. 1 version of MUE contains edits for about 9,700 HCPCS/CPT codes that have been assigned unit values for MUEs. MUEs are cumulative for each quarter. However, CMS did not publish all MUEs on Oct. 1; additional edits will be posted Jan. 1. CMS says it is unable to 'publish all active MUEs because some are primarily designed to detect and deter questionable payments rather than billing errors. Publishing those MUEs would diminish their effectiveness."

The edits are published on the CMS Web site.