Translation updating of cms occurring

Posted by / 05-Aug-2020 13:36

Translation updating of cms occurring

Suppliers will need to request a redetermination with medical documentation to support the need for excessive items denied based on MUE values.

When clerical/billing errors occur and denials are issued based on MUE edits, suppliers may request a claim reopening to correct the number of units or date span.

An MUE for a HCPCS code is the maximum units of service that a provider would bill under most circumstances for a single beneficiary on a single date of service.

These edits are set to deny claim lines exceeding the acceptable maximums.

The denials are identified by ANSI Reason Code 151 with Remark Codes N115 or M25 on the remittance advice. Some MUEs are confidential and are for CMS and Medicare Contractors' use only.

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Suppliers cannot issue Advance Beneficiary Notices of Noncoverage (ABNs) for units of service in excess of MUEs.