Frequency Edits Being Incorporated into CCIs and OCEs

CMS has established units of service edits called Medicare Unbelievable Edits (MUEs) effective July 01, 2005. The edits will test the same beneficiary, procedure code, dates of service and billing provider against a criteria number of units of service. Beginning April 01, 2005 the CCI edits will contain a revised table of MUEs. The MUE table will be provided on a quarterly basis to Medicare Part B to the Outpatient Code Editor (OCE) maintainer for installation into the OCE for hospitals subject to outpatient prospective payment system bill types 12x and 13x. The OCE will generate the edit for MUEs, which will result in a line item rejection. CMS will require quarterly updates to the MUE table as part of CCI instructions.