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ACLA Lauds Deadline Delay for 'Medically Unbelievable Edits'

Posted on: Tuesday, 14 March 2006, 18:00 CST

WASHINGTON, March 14 /PRNewswire/ -- The American Clinical Laboratory Association today applauded the Centers for Medicare and Medicaid Services for allowing more time for comments on "Medically Unbelievable Edits" and extending the implementation date of the MUE program.

CMS's action comes after a concerted effort by ACLA, along with other medical specialty and health provider groups. These groups raised serious concerns about how the MUEs were developed and proposed for implementation.

Alan Mertz, president of ACLA, has offered to work with CMS and its contractor, Correct Coding Solutions, LLC, to ensure that the MUE requirements match current medical practice and are used only as intended -- to prevent the payment of obviously erroneous Medicare claims submissions -- rather than to establish medical policy.

ACLA was one of the first groups to meet with high-level CMS officials to raise concerns. The organization wrote CMS Administrator Mark McClellan soon after the proposal was first announced in January. ACLA met with CMS officials in late February.

ACLA was most concerned that the proposed unit-of-service edits fly in the face of accepted medical practice. ACLA saw the proposed standards as contrary to the conventions established when laboratory CPT codes were developed. Thus, if implemented, Medicare recipients would face negative health care consequences.

The association provided examples of likely problems. For example, under the initial MUE proposal, if four polyps were removed during a colonoscopy for biopsy, the pathologist would be limited to billing for two interpretations. The MUEs would impose such arbitrary limits on more than 10,000 CPT codes.

ACLA cited several concerns with the proposal, including: * The MUEs were developed without appropriate CMS guidance as to their purpose; * A process to appeal the edits was lacking; * The methodology used to develop the edits was not disclosed; * There was insufficient stakeholder involvement in the MUEs' development.

ACLA subsequently asked CMS to suspend all deadlines for comments associated with the initiative and to withdraw the MUE program.

ACLA is an association that represents local, regional and national clinical laboratories throughout the United States.

American Clinical Laboratory Association

CONTACT: Jim Edwards, +1-202-467-8206, for American Clinical LaboratoryAssociation

Source: PRNewswire

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