AHA Coding Clinic® for HCPCS - 2005 Quarter 2; FOR your INFORMATION
Reactivation of modifier 27
Effective January 1, 2005, modifier 27 was erroneously deleted from the OPPS OCE software. Because of this, claims containing this modifier for services furnished on or after the period of 01/01/2005 through 03/31/2005 were returned to the provider. After successful implementation of the April 2005 OCE release to correct the error, providers can submit an adjusted bill for the services that were provided with modifier 27 appended to them to receive payments. ...
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Article Overview
This article covers a correction to an outpatient claims-edit issue in the CMS OPPS OCE software and the related reprocessing of claims from an early-2005 date range. It is relevant to hospital outpatient billing staff, coders, and revenue cycle teams who monitor claims edits, software releases, and adjusted billing activity. The article focuses on the affected modifier, the time period involved, and the operational update tied to the April 2005 OCE release.
Why This Topic Matters
It helps billing and coding teams understand a temporary system issue that affected claim handling and the later correction that allowed impacted claims to be resubmitted or adjusted.
What You Will Learn
- The general nature of the outpatient claims-processing issue
- Which CMS payment-system update corrected the problem
- What type of billing follow-up was associated with impacted claims
- The early-2005 period affected by the software issue
Who Should Read This
- Hospital outpatient coders
- Billing specialists
- Revenue cycle staff
- Claims processing personnel
Modifiers Discussed
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