Healthcare organizations will encounter an additional barrier to payment for Medicare outpatient claims this summer, according to JD Supra.
Three details:
1. Beginning in July, CMS will reject a Medicare outpatient claim if:
- The service location address doesn't exactly match the address listed on the 855A enrollment form in the Provider-Enrollment, Chain and Ownership System
- A hospital with multiple locations doesn't report the correct location where the service was rendered
2. The guidance means spelling differences or abbreviations — such as "Rd." instead of "Road" — can cause an outpatient claim to be rejected.
3. CMS created a query function allowing hospitals to cross-check their claim addresses with the ones listed in PECOS. JD Supra advised hospitals to immediately begin reviewing the records "so as to avoid potential roadblocks."