decisionhealth Newsletters, Answer Books - 2006 Issue 10 (October)
Medicare_Claims_Processing_Manual / 440
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Article Overview
This article explains a 2005 CMS update to Medicare Claims Processing Manual Chapter 18 affecting screening Pap smear and pelvic examination claims. It is relevant to billers, coders, and Medicare contractors who handle preventive and screening services, because it describes changes to Common Working File edits, covered diagnosis reporting, and related billing and denial messaging for these services. The article also identifies the applicable HCPCS and diagnosis codes used in these claims and notes the effective and implementation dates for the update.
Why This Topic Matters
The update affects how Medicare screening claims are processed, how diagnosis information is reported, and when claims may pay or deny under the editing system. Understanding the scope of the change helps reduce claim rejections and supports correct handling of preventive screening services.
Article Sections
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Summary of Changes
Overview of the transmittal and the general scope of the Medicare claims processing update. Covers the affected screening services and the timing of the change.
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General Information
Background and policy context for the editing update. Describes the claim-processing issue, the affected screening services, and provider education references.
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Business Requirements
Administrative requirements and implementation notes associated with the change request. Includes references to system and contractor handling considerations.
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HCPCS Codes for Billing
Billing guidance for screening Pap smear services by payer type and setting. Identifies the code sets and billing categories addressed by the manual update.
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Diagnosis Codes
Diagnosis reporting guidance for screening Pap smear and pelvic examination claims. Describes the low-risk and high-risk coding framework used in claim edits and billing.
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Payment Method
Payment handling for screening pelvic examination services across Medicare billing environments. Summarizes the applicable payment frameworks and provider settings.
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Revenue Code and HCPCS Codes for Billing
Billing instructions for pelvic examination services in carrier and facility contexts. Addresses related revenue code usage and claim submission categories.
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MSN Messages
Standard beneficiary notice messaging used when screening services are denied for frequency reasons. Covers the general denial message format.
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Remittance Advice Codes
Remittance advice messaging used for claim denials involving screening service frequency limits. Covers the general categories of reason and remark coding.
What You Will Learn
- How CMS updated Medicare claims processing for screening Pap smear and pelvic examination services
- Which sections of the Medicare Claims Processing Manual were revised
- What types of billing and diagnosis guidance were added or revised
- How the article addresses payment and denial processing in different Medicare settings
- What administrative and contractor-facing implementation details accompany the update
Who Should Read This
- Medical coders
- Billing staff
- Medicare claims processors
- Provider offices
- Hospital outpatient billing teams
- RHC/FQHC billing staff
- Contractors
Codes Discussed
Modifiers Discussed
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