AHA Coding Clinic® for HCPCS - 2005 Issue 3; FOR your INFORMATION

Reprocessing of OPPS claims containing surgical procedures

An error was discovered in the 2005 OPPS PRICER that miscalculated the outlier payment amount. The error was corrected in the July 2005 version of the OPPS PRICER. By September 15, 2005, FI’s should mass adjust all claims that meet all of the following criteria using the corrected July 2005 OPPS PRICER: 1. Claims were processed using the January or April 2005 OPPS PRICER prior to the July 2005 OPPS PRICER installation; and 2. Claims with one or more surgical procedure lines (lines with status indicator of “T” or “S” with HCPCS codes greater than 09999...

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