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Medicare Updates and Notices

Beginning July 1, 2019, Medicare will reject hospital outpatient claims if the service location address on the claim does not exactly match the address on record in the Provider-Enrollment, Chain and Ownership System (“PECOS”). Any discrepancies, such as the difference between “Road” vs “Rd” or “Suite” vs “Ste”, may result in substantial payment delays.

In MLN Matters Article SE19007, CMS describes a new query function that allows providers to view what is on file with PECOS for their practice locations. If you have not done so already, we suggest the Hospital validate its claims submission system to the PECOS information for all outpatient service locations, including off-campus provider departments. Providers who need to add a new or correct an existing practice location address will still need to submit a new 855A enrollment application in PECOS.

Additionally, this is a good time to review MLN Matters Article SE18002. This article offers a summary of billing requirements (with examples) for OPPS providers with multiple service locations.

If you have any questions or would like additional information, please contact Maddie Gookins 317-713-7945, or mgookins@blueandco.com.

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