Published on: May 22, 2006
CMS Announces MUEs Will Be Limited and Phased-In
Announcement appears to be good news for pathology and laboratory community, according to CAP
Washington, D.C. – A representative from the Centers for Medicare and Medicaid Services (CMS) today announced that the initial list of Medically Unbelievable Edits (MUEs) intended for implementation in January 2007 will be much less restrictive than the current proposal. Lisa Zone, Deputy Director of CMS’s Program Integrity Department, made the announcement during her testimony before the Practicing Physicians Advisory Council (PPAC) and noted that the unit of service edits during the initial phase-in will focus largely on anatomic anomalies and obvious typographical errors. Ms. Zone also noted that CMS is seriously considering the use of modifiers and the development of an appeals process.
The MUE proposal released on January 18 would have imposed units of services limitations on each and every physician service under Medicare and would have resulted in automatic denials of all claimed units in excess of the criteria units of the service ceiling. The shorter MUE list will be released for public comment in late August, according to Ms. Zone.
“Our efforts to work with CMS seem to be moving in the right direction, and this announcement appears to be good news for the pathology and laboratory community,” said Thomas M. Sodeman, MD, FCAP, president of the College of American Pathologists (CAP). “We want to thank CMS for their willingness to discuss with us our concerns with the current proposal and offering these anticipated changes.”
Earlier this month, CAP representatives met with Kim Brandt, Director of Program Integrity to further outline our concerns in more detail. At that meeting, Ms. Brandt proposed many of the changes that were formally announced at PPAC today.
A College-led coalition of 60 pathology and laboratory groups has consistently stated to CMS that while they would like to provide useful comments on the proposed MUEs, clarification is needed on a number of important issues, including the rationale and methodology for current edits and the policy for overriding modifier use and appeal. In addition, the coalition has suggested that not all pathology and laboratory services may be candidates for MUE’s.
CMS urges medical societies to provide comments on the proposal by June 19th to help them further refine the proposal.
The College of American Pathologists (CAP) is a medical society serving about 16,000 physician members and the laboratory community throughout the world. It is the world’s largest association composed exclusively of pathologists and is widely considered the leader in laboratory quality assurance. The CAP is an advocate for high quality and cost-effective patient care.