AHA Coding Clinic® for HCPCS - 2008 Quarter 4; FOR your INFORMATION
Holding of certain screening pap smear claims billed by Outpatient Prospective Payment System (OPPS) providers
Since September 4, 2008, the Centers for Medicare & Medicaid Services (CMS) has instructed their contractors to hold all claims containing HCPCS code Q0091 submitted by OPPS facilities, due to systems issues related to an incorrect deductible and coinsurance assignment of Screening Pap Smears claims containing Healthcare Common Procedure Coding (HCPCS) code Q0091 , (Screening Papanicolaou (Pap) smear, obtaining, preparing and conveyance of cervical or vaginal smear to laboratory), on OPPS claims. These claims will be held by contractors until the successful implementation of the Outpatient Code Editor (OCE), scheduled for January 5, 2009. In the interim, OPPS facilities may...
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Article Overview
This article explains a CMS-directed hold on a specific category of outpatient claims tied to a system issue under OPPS. It is relevant to billing and revenue cycle staff who handle Medicare outpatient submissions and want to understand the operational impact, timing, and related CMS system implementation context.
Why This Topic Matters
The notice affects claim processing timing for OPPS facilities and highlights a temporary Medicare systems issue that could delay reimbursement for affected claims. It also provides context for how CMS instructed contractors to handle the issue during the implementation period.
What You Will Learn
- The Medicare outpatient claim-processing issue described in the notice
- The timeframe associated with the temporary hold
- The role of CMS and contractors in handling affected claims
- Operational considerations for OPPS facilities during the system update period
Who Should Read This
- Hospital outpatient billing staff
- Revenue cycle professionals
- Coding specialists
- Medicare compliance staff
- Claims processing teams
Codes Discussed
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