EMK
Contributor
Hoping someone can shed some light on this issue we are experiencing. We are billing a 52000 on both the facility (ASC) and professional-Dr. side these are 2 separate entities with 2 different NPI's and Tax ID's. Per MUE guidelines the allowance is 1 unit. Wellcare Medicare is continuing to deny our facility (ASC) claims stating we have exceeded the MUE guidelines. 
To our knowledge the MUE guidelines does not prevent you from billing the 1 unit as both a professional and a facility claim and our other carriers are paying for it with out question. However, Wellcare states when the MUE exceeds the max allowed on a single claim or across multiple claims then they will deny off the excess therefore they deny the facility (ASC) claim . We have tried speaking to Wellcare managers and appealing the claims sometimes they will pay others they will stay true to the denial again saying it is due to the MUE. We can not find anything in writing to confirm the information provided by Wellcare. Suggestions or advice please.
To our knowledge the MUE guidelines does not prevent you from billing the 1 unit as both a professional and a facility claim and our other carriers are paying for it with out question. However, Wellcare states when the MUE exceeds the max allowed on a single claim or across multiple claims then they will deny off the excess therefore they deny the facility (ASC) claim . We have tried speaking to Wellcare managers and appealing the claims sometimes they will pay others they will stay true to the denial again saying it is due to the MUE. We can not find anything in writing to confirm the information provided by Wellcare. Suggestions or advice please.