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Medicare Program Integrity: Few Payments in 2011 Exceeded Limits under One Kind of Prepayment Control but Reassessing Limits Could Be Helpful
Kathleen M. King (au)
The Centers for Medicare & Medicaid Services (CMS) has estimated improper Medicare fee-for-service payments of $29.6 billion in fiscal year 2012. To help prevent improper payments, CMS has implemented national Medically Unlikely Edits (MUEs), which limit the amount of a service that is paid when billed by a provider for a beneficiary on the same day. The limits for certain services that have been fraudulently or abusively billed are unpublished to deter providers from billing up to the maximum allowable limit. This report reviewed issues related to MUEs. It examines the extent to which CMS has (1) paid for services that exceeded the unpublished MUE limits and (2) examined billing from providers that exceeded unpublished MUE limits. This is a print on demand report.
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