Clinicians who bill drugs to Palmetto GBA should brace themselves for a semi-automated review of their drug claims. And clinicians in other jurisdictions might want to take note of Palmetto’s maximum allowed units (MAUs).
 
Recovery auditor (RAC) CGI is checking claims from Ohio and Kentucky, while RAC HDI will tackle the claims of doctors and non-physician practitioners (NPPs) in California, Hawaii and Nevada. In all five states, the RACs will determine whether drug claims exceeded Palmetto’s MAUs claims edit based on the medically unlikely edit. When the medical necessity of extra units is not supported by additional documentation, the RAC will find an overpayment.
 
While it appears that Palmetto is the only carrier that now uses MAUs, we know how carriers like to borrow ideas that control costs and cut overutilization. So if you’re not in a Palmetto state, don’t assume MAUs aren’t in your future.
 
Readers of the Anesthesia & Pain Coder’s Pink Sheet know how confusing it can be to report the correct unit number for drugs, but they also know they can turn to the newsletter and its website for guidance, HCPCS code look up and more. They also can expect the newsletter to keep track of the new claims edit.