https://www.aad.org/dw/dw-weekly/2018/july-4 Medicare announces new MUE limit for aminolevulinic acid HCI, 10% (Ameluz) As a result of the AAD/A’s and drug manufacturer Biofrontera’s advocacy efforts, Medicare has decided to vacate its initial decision to limit Ameluz medically unlikely edits (MUE) to 3 units, and increase it to 200 units effective July 1, 2018. In his correspondence to the AAD, Niles Rosen, MD, of Correct Coding Solutions LLC and on behalf of CMS ― which owns MUE and determines its contents ― stated “The MUE value for practitioner and outpatient claims for this code will be three (3) effective July 1, 2018. CMS will increase the MUE value to 200 in the Oct. 1, 2018, version of MUE updates. This change will be retroactive to July 1, 2018. This MUE is a date of service edit.” Dermatologists should be advised that when the billed units of service (UOS) for HCPCS code J7345 are denied based on MUE values, the practice can appeal the denial. Medicare Administrative Contractors (MACs) will pay UOS in excess of the MUE limit if documentation supports medically reasonable and necessary UOS in excess of the MUE value. Because the MUE increase will be reflected on Oct. 1, 2018, providers may choose one of the following options for services rendered prior to Oct. 1: Delay submission of claims for this code until after that date; Appeal claim denials due to MUE providing documentation with the appeal; or Resubmit claims denied due to the MUE after Oct. 1, 2018, if allowed by the A/B MAC or state Medicaid program. Important note: Dermatology practices cannot use an Advanced Beneficiary Notice (ABN) to seek payment from a Medicare beneficiary for services denied based on an MUE. If a claim denial is based on an MUE denial, the unpaid claim is considered a provider liability. For more information, contact the Academy’s Manager of Coding and Reimbursement Faith McNicholas at fmcnicholas@aad.org.
Thanks Jeff Holm for the “Marketing Message.” Let’s be very clear and honest. You are completely useless! You provide zero value to the organization and you have ZERO clout within Dermatology. Please resign or get fired @ Biofrontera. Only chance we have in the field. #Derms hate you #we hate you #fail elsewhere Vote to fire? B Rose J Holm Rose is the worst, however Holm is useless. Please relieve the pain.
Reimbursement continues to be a nightmare for Ameluz. I regret that we ever invested in their product. Why can’t they get their issues fixed?
