MAOs are receiving EDFES edit 178 “Submitted Charges” when the charges exceed $99,999.00. Can CMS provide a prevention or resolution strategy for this edit?
Answer:
This edit applies to the header level on Professional records in the Encounter Data Front End System (EDFES). Given the current edit, CMS recommends splitting the Encounter Data Record (EDR) into two separate records. It is important to note that, in order to avoid a duplicate record rejection in the Encounter Data Processing System (EDPS), the submitter should also split the services (e.g., procedure code, modifier, etc.) along with the billed amount across multiple encounters. Assuming the services as well as the amounts are allocated across multiple EDRs, the duplicate edit will not be triggered since the data elements that are checked in the EDPS duplicate logic will differ across the EDRs.
Source: User Group Q&A Documentation from January 19, 2017
Last Updated: 01/19/2017