Modification to Accommodate the Acute Care Episode (ACE) Demonstration from the CMS website: Pub 100-19 Demonstrations SUMMARY OF CHANGES: The Centers for Medicare and Medicaid Services (CMS) issued change request (CR) 6001 on June 27, 2008 to implement the necessary requirements for the ACE demonstration project. Under the ACE demonstration, CMS is issuing a single […]

FAQs on Observation, Condition Code 44 from the CMS website   QUESTION: May a hospital report drug administration services, such as therapeutic infusions, hydration services, or intravenous injections, furnished during the time period when observation services are being reported? ANSWER: The Medicare Claims Processing Manual (Pub 100-4), chapter 6, section 290.2.2 states that “observation services […]

What is the CMS Medically Unlikely Edit (MUE) program? The CMS Medically Unlikely Edit (MUE) program was developed to reduce the paid claims error rate for Medicare claims. MUEs are designed to reduce errors due to clerical entries and incorrect coding based on anatomic considerations, HCPCS/CPT code descriptors, CPT coding instructions, established CMS policies, nature […]