QUESTION: Is there an appeal process for claim lines denied based on Medically Unlikely Edits (MUEs)?
ANSWER: Since claim lines are denied at Carriers and Part A/Part B Medicare Administrative Contractors (A/B MACs) Processing Claims with the MCS system and at Durable Medical Equipment Medicare Administrative Contractors (DME MACs) processing claims with the VMS system, MUE-based claim line denials at these contractors may be appealed. However, at FIs and A/B Macs Processing Claims with the Fiscal Intermediary Shared System (FISS), claims with a claim line with units of service exceeding an MUE value are returned to the provider. No claim denial occurs, and appeals are not available. Appeals should be submitted to local contractors not the MUE contractor, Correct Coding Solutions, LLC
For more information : Join our exclusive FREE Email Coding News Alert Mailing List http://www.codinginstitute.com/
ANSWER: Since claim lines are denied at Carriers and Part A/Part B Medicare Administrative Contractors (A/B MACs) Processing Claims with the MCS system and at Durable Medical Equipment Medicare Administrative Contractors (DME MACs) processing claims with the VMS system, MUE-based claim line denials at these contractors may be appealed. However, at FIs and A/B Macs Processing Claims with the Fiscal Intermediary Shared System (FISS), claims with a claim line with units of service exceeding an MUE value are returned to the provider. No claim denial occurs, and appeals are not available. Appeals should be submitted to local contractors not the MUE contractor, Correct Coding Solutions, LLC
For more information : Join our exclusive FREE Email Coding News Alert Mailing List http://www.codinginstitute.com/
