We wanted to remind providers that starting in July 2019 CMS will reject claims for services provided in off-campus hospital outpatient departments (HOPDs) if a provider’s address on the claim does not exactly match the address used in Medicare enrollment. And CMS means exactly match. For example, if one address is “Maple Avenue.” and the other address is “Maple Ave.,” then the claim will be rejected because the addresses are not an exact match. The purpose of these validation edits is to determine whether an entity has moved locations and should no longer qualify for the higher reimbursement as a HOPD, but the broad sweeping policy could have negative consequences for other providers with minor address inconsistencies. We recommend that providers verify that the address on their claims exactly match the address in PECOS. CMS has provided guidance and instructions entitled “Activation of Systematic Validation Edits for OPPS Providers with Multiple Service Locations.” Please let us know if you have any questions or concerns about this process.

Click here to view our Health Care Services page

Contact:

Daniel C. Soldato dsoldato@wyattfirm.com 859-259-0649

Carole D. Christian cchristian@wyattfirm.com 502-562-7588