Medically Unbelievable Edits (MUE) represent the Centers for Medicare & Medicaid Services’ (CMS) plan to detect and avoid paying for medical errors and implausible claims submissions (eg, a hysterectomy performed on a man). An initial proposal would have restricted the units of services that could be billed per patient per day for more than 10,000 CPT and HCPCS level II codes. Some medical societies objected that the unit limits “contradict current well-established, evidence-based medical practice,” according to a letter to CMS signed by more than 90 medical societies, including the American Society of Clinical Oncology. There also was no procedure for modifying or appealing an edit. CMS initially intended to implement the MUEs by July 1, 2006.
CMS later agreed not to implement MUEs before January 1, 2007. At the most recent meeting of the CMS Practicing Physicians Advisory Council (PPAC), a CMS official announced that a small subset of MUEs will be published for public comment in the fall and implemented on January 1, 2007. This subset will focus on identifying anatomical and typographical errors in claims submissions.
PPAC recommended that CMS allow modifiers for clinical outliers and allow appeals from claims denied under the MUE program. It also advised CMS to release background about the context and rationale for the MUE program and data regarding the estimated percentage of errors that CMS hopes to address. These moves would address objections raised by the medical societies in their letter to CMS.
About 1.7% of Medicare claims paid in error relate to mistakes in billing and coding, said Lisa Zone, deputy director of the Program Integrity Group in the Office of Financial Management at CMS. This amounts to billions of dollars. A link to the transcript of the most recent PPAC meeting can be found on the CMS website.

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